Page 37 - Forbes - India (January 2020)

AyushMAN BhArAt

‘The Private Sector some empirical evidence to support
us because we have done close to 67
Will Never Be Happy’ lakh treatments [as of early December
2019] and out of this, more than 50
percent are done by private players.
Dr Indu Bhushan, CEO, Ayushman Bharat, on If these rates were so unviable,
how do you explain close to 40 lakh
why private players need to change their mentality, treatments by the private sector?
and making the scheme foolproof There is some disconnect somewhere.

amit verma Q Providing a continuum of care
Q Studies have shown that the between the primary ‘health
Rashtriya Swasthya Bima Yojana and wellness centres’ and
(RSBY) didn’t reduce patients’ out-of- hospitals providing secondary
pocket expenditure (OOPE). How will and tertiary care is critical for the
Ayushman Bharat overcome that? success of Ayushman Bharat.
RSBY was a narrow scheme. It did not Ayushman Bharat provides support
cover catastrophic illnesses that push for secondary and tertiary care, but
people into poverty. Primary health we have to have a close link with
care was also not covered under it. the primary health care pillar under
So the impact of OOPE may not have which 1.5 lakh health and wellness
been noticed. But one also has to centres are being developed. A lot
see that OOPE has other correlates, of the initial screening for diseases,
the largest being incomes. As your including non-communicable ones,
income increases, OOPE will also will take place there and those
increase. In RSBY, we saw that OOPE patients who are found to be positive 37
increased because previously people will be sent for treatment. The
were not going to hospitals. Once the treatment should be followed up at the
patient went to hospital, he got a lot of centres. The whole circle of screening,
treatment for free, but he had to pay ensuring preventive care, linking it
for some, including transport, food, with the treatment and then providing
loss of wages etc. Usually with OOPE, curative and rehabilitative support
it’s like an inverted-U. When no health “when no health can be done at the community level
care services are available, OOPE is care serVices are by the primary health and wellness
zero. But as health systems improve, aVailaBle, out-of- centres. That linkage is still missing
OOPE first increases and then it comes and we need to work on that.
down. So one has to see where you are Pocket-exPenditure
catching the curve in terms of impact. (ooPe)is zero. But Q There have been instances of
empanelled hospitals gaming
Q The package rates are a pain as health systeMs the system. How do you
point for private players. How iMProVe, ooPe first prevent fraud and abuse?
are you approaching the issue? We want to ensure that our checks
These prices are quite reasonable. increases and then and balances are so strong that no
They are based on rigorous studies it coMes down.” fraud takes place. And if it does, we
and a wide range of consultations, should be able to detect it quickly and
including with the private sector. The take action. We have de-empanelled
private sector will never be happy a number of hospitals. We are in the
because they want to take more and process of finalising a vendor who
more. We are providing them with and take… they have to change their can help us with big data analysis
volume, and we keep saying we want mentality and whenever we find some and artificial intelligence to spot
the industry to move to a high volume of our prices are not right, we will potential fraud cases. We are also in
and low margin approach, rather keep modifying them. We’ve done the process of engaging medical audit
than low volume and high margins the first round of modifications and agencies to carry out audits based on
that they have right now. So it’s a give believe they are fine. We also have suspicious as well as random cases.

january 31, 2020 • forbes india