Sunday, 16 December 2018

India’s dilemma in providing affordable healthcare

17 September 2018 | Features | By Ajoy Khandheria

The government is all fuelled up to design in detail the Jan Arogya Abhiyan which is about to be launched.

The predicament that most healthcare enterprises face is how to make healthcare delivery sustainable in India. Not even profitable, but sustainable, which would essentially include the ability to meet the growing expenditure of healthcare delivery.

With over 1.3 billion people to treat, the volume is on our side. However, the majority of population is far from being capable to afford basic levels of healthcare. With around 22% population below the poverty line, with daily unit expenditure of Rs 27 in rural areas and Rs 32 in urban areas, medical treatment becomes a far-fetched dream. This means around 350 million people are officially poor.

Consider some other aspects. Over 68% population is based in rural areas, which has acute shortage of healthcare facilities. In brief, it can be said over 68% population in the country has minimal access to healthcare. Healthcare workforce is far from being adequate, with 1:921 doctor-to-patient ratio while the country is falling short of an estimated 1.94 million nurses. In terms of facilities, India has around 0.9 beds per thousand people.  Surely, the challenges are humongous and many.

Given the context, Government and private bodies are faced with the problem of devising a method to make basic healthcare delivery sustainable, ensure quality medical care services, reduce dependency on secondary and tertiary healthcare centres, and penetrate the villages of India.

 

Jan Arogya Abhiyan: Noble Idea Needs Ground Support

The government is all fuelled up to design in detail the Jan Arogya Abhiyan which is about to be launched. The initiative which is targeted to impact 50 crore Indians by providing medical care is the first of its kind venture that’s being conducted at a scale never imagined before. Howsoever it may seem challenging, Shri Indu Bhushan, along with the likes of Shri  Amitabh Kant and Dr. Vinod K Paul, is at helm for planning and implementation of the scheme, and in the leadership, the Ayushman Bharat team has taken into due consideration the essentiality of two features: one that serves as a medium and the second that serves as a ground support.

IT based healthcare delivery system. The Ayushman Bharat scheme will be a platform driven initiative, which would have to be customized as per the need of state. The identification of patient is not based on Aadhar, yet the government has plans to uniquely identify those who are eligible to reap benefits.

Ground network of secondary and tertiary healthcare delivery providers. It is vital that the government realizes the massive importance of getting private partners on-board.  The call to hospitals inviting them to join India’s health revolution is a major step forward in boosting public private partnership which was long wanted by the healthcare delivery system of the country.

Another important feature is that the government is keen on rolling-in the program in states where it already has a health insurance scheme in place and integrate the two systems. The routing of the money in transparent and effective way is essential to the success of the scheme.

 

Solving the Dilemma

The partnering of Jan Arogya Abhiyan with a for-profit rural healthcare delivery model, which is running successfully would be another step forward to solve the dilemma of providing affordable healthcare. What is important is to determine whether the two models are complimentary and will help meet the objectives.

In the Gramin experience, we have a model in place, which since its inception in 2016 has spread across six states with over 120 centres benefiting 1.5 lakh people in tier 3 villages or below. The model provides a system that integrates primary, secondary, and tertiary care at a cost that’s complimentary to the government program. The model aligns well with ModiCare. Finding such initiatives and integrating with them would provide the Jan Arogya Abhiyan a full network of hospitals, tertiary centres, diagnostic avenues, and primary healthcare centres. As each centre begins to break even and become profitable, the initiative is able to grow and sustain itself.  Partnering with such initiatives will help the government access a complete network rather than individual hospitals and it will further boost the government’s initiative and make achieving the goal of affordable healthcare for the masses easy.

 

Ajoy Khandheria, Founder, Gramin Health Care

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