Page 33 - Forbes - India (January 2020)

AyushMAN BhArAt

Nilotpal Baruah
So far, the government claims to cases every year (5.4 hospitalisations
have issued 11.78 crore cards. per 100 people enrolled, assuming
Unlike RSBY, which required 50 crore people are covered)—in the
individuals to enrol themselves first 12 months, 46.5 lakh patients
into the scheme at a particular received treatment under AB-PMJAY,
time of the year, AB-PMJAY is an but as awareness picks up, more
entitlement-based scheme. Cards patients will follow—and `20,000 is
have either been sent to eligible the average package rate, it works
individuals based on the SECC 2011 out to a total of `54,000 crore, at
data or they can approach an ‘Arogya current prices. If 40 percent of the
mitra’ stationed at every empanelled cost is borne by the states, that leaves
hospital to get a card made on `32,000 crore for the Centre to foot.
the spot. “This is a considerable “The entire budget of the Ministry
difference between the two schemes of Health and Family Welfare is
and one that is less exclusionary “the goVernMent, `62,000 crore. So you’re talking
for a patient seeking care,” says Dr health care ProViders about half of that just for PMJAY,”
Indranil Mukhopadhyay, health he says. “And mind you, `20,000 is
economist and associate professor at and Patients will far below the average package rate,
OP Jindal University, in Haryana. haVe to go through so this is a base level estimate.”
Another difference between the “I am not suggesting that the
two schemes is that states are given teething trouBles for scheme needs more money… I
the flexibility to implement AB- the next year or so am saying the insurance model is
PMJAY in the way they like. They Before things start inherently a cost escalating one,”
can opt for an insurance-based model, says the professor. RSBY, with its
deploying an insurance company running sMoothly.” `30,000 coverage, for instance, had a
to handle the claims or they can go premium ranging from `350 to `900, 33
with a trust model where the state dr devI Shetty, Founder and with the amount increasing every
government handles the claims. Of chairman, narayana hrudayalaya year. With PMJAY too, as the number
the 33 states and Union Territories hospitals of claims increase, premium prices—
that have taken up the scheme—Delhi, currently at around `1,100—will shoot
Telangana, Odisha and West Bengal up. Reimbursements demanded by
are not yet on board—a handful have “We are lucky,” says 30-year-old Amir. hospitals will consequently increase.
opted for a mixed model, combining He left Kishanganj a few years ago to However, Bhushan bets that as
the best of the insurance and trust settle in Mumbai where he teaches the number of claims increases,
models. Some states like Karnataka Arabic at a madrassa. It pays him the marginal costing of hospitals
and Kerala, which had seven and `6,000 a month. He rents a room in will decrease. “Eventually we want
three state health insurance schemes a chawl in Malad and gives tuitions hospitals to move to a high volume,
in place respectively, are in the to supplement his income. “I end up low margin model,” he says.
process of subsuming them under earning a total of `10,000 to `15,000 a Hospital executives tend to
AB-PMJAY, says Bhushan. Others month. Without this,” he says, holding disagree. “You can’t run hospitals like
like Maharashtra, which runs the up the pink card, “we would not have factories,” says the head of one leading
Mahatma Jyotiba Phule Jan Arogya come so far.” Tasneem, still hunched private hospital chain on the condition
Yojana (MPJAY) health insurance over her bed, nods in agreement. of anonymity. “Doctors and nurses are
scheme (previously known as the human and can only work so many
Rajiv Gandhi Jeevandayee Arogya n 2018, the government allocated hours in a day. The whole ‘economies
Yojana), is implementing AB-PMJAY `1,200 crore to the primary health of scale’ argument just doesn’t
as a parallel scheme. The former has I care pillar of Ayushman Bharat work in the health care sector.”
a medical cover of `1.5 lakh. Once and `2,000 crore to insurance pillar, AB-PMJAY currently covers
that amount is used, then only can PMJAY. The following year, the latter 1,393 medical procedures, and the
patients dip into the additional `5 was ramped up to `6,400 crore. package rates for them are between
lakh offered under AB-PMJAY. “This is far below what is needed to 40 percent and 80 percent lower than
In Bihar, Tasneem and Amir’s deliver what the government claims,” what private players charge. Months
home state, no state health insurance says Mukhopadhyay. If, he reasons, after the scheme was launched, the
scheme existed prior to AB-PMJAY. you have 2.7 crore hospitalisation Association of Healthcare Providers, a

january 31, 2020 • forbes india