AYUSHMAN BHARAT AND COOPERATIVE FEDERALISM IMPLICATIONS
What in news Ayushman Bharat and cooperative federalism implications?
- Based on the ongoing centrally sponsored scheme, the Rashtriya Swasthya Bima Yojana, the Central government launched an improved version in 2018 called the National Health Protection Scheme (NHPS) for a sum assured of ₹5 lakh per family per year.
- But West Bengal, Telangana, Delhi and Odisha not opt to join Ayushman Bharat.So that, the question arises whether the scheme is hurting the idea of cooperative federalism.
Highlights of Current Healthcare status in India:
- Poor condition of healthcare in country
- Lack of infrastructure;
- Poor health services in government hospitals; Private hospitals out of reach of most people.
- According to the Global Burden of Disease study, India is ranked low in theHealthcare index; India stands at a rank of 154.
- But despite this, the budget allotment on healthcare services is extremely low. India spends less than 2% of her GDP on public healthcare.
What is Ayushman Bharat:
- The National Health Protection Mission or Ayushman Bharat Yojana, launched by the Government is the first major step.
- Ayushman Bharat Yojana is a program which aims to create a healthy, capable and content new India.
- It will also focus on the poor and weaker sections of the society.
- It aims to provide insurance of up to 5 lakh rupees to each family.
- The new scheme also intends to improve secondary and tertiary healthcare services for crores of Indians.
There are two flagship initiatives under Ayushman Bharat:
- Pradhan Mantri Jan Arogya Yojana (PMJAY):
- Under this scheme, 1.5 lakh health sub-centres are being converted into health and wellness centres.
- It will bring the healthcare system closer to the people.
- The centres will provide comprehensive healthcare, including treatment for non-communicable diseases and maternal and child health services.
- Besides this, they will also provide free essential drugs and diagnostic services
- 1200 crore have been allocated for this flagship programme.
- The scheme will cover more than 10 crore poor families, which is approximately 50 crore persons.
- It will also setup wellness centres which will give poor people OPD facility near their homes.
- National Health Protection Scheme:
- The National Health Protection Scheme will cover over 10 crore poor and vulnerable families.
- It will provide coverage up to 5 lakh rupees per family, per year for secondary and tertiary care hospitalization.
What is Cooperative Federalism
- Cooperative federalism, by definition, is a system where the national and state governments of a country work together to solve common problems.
- But, this is contrast to an arrangement where there is a strict separation of powers between the various levels of a government, or to a unitary system of government in which a more powerful federal government tries to enforce its will on the subordinate governments.
Ayushman Scheme: Effect on Co-operative Federalism
- The Seventh Schedule of the Constitution makes States responsible for hospital services. Moreover,the States have their own schemes to provide financial risk protection in medical relief.
- Political : But on replacing Ayushman Bharat with existing State health insurance schemes seems to favour only central government , not the State government.
- Eventhough State governments are equal partners funding 40% of the scheme and bearing its implementation for covering double the number of beneficiaries.
- Fund allocation for the scheme: Given that the Central government transfers funds to States through the Finance Commission, it is expected of the National Health Agency (NHA) to build an institutional architecture, standardise procedures, costs and access all data for effective monitoring.
- Funds on condition : This is important as it is accountable to Parliament and the Comptroller and Auditor General for the proper utilisation of allocated funds. But such standardization(type of funds) can affect innovation and entail costly structures that may not accommodate local conditions, preferences, and cost-effective solutions.
- Funds without condition : Instead, when funds are provided without any condition , certain goals can be achieved. Besides, States have scope to innovate, model the design to fit their context , take total ownership and alsobe accountable for outcomes.
- The NHA’s approach does not appear to be built on consensus. Its model consists of outsourcing the vital functions of pricing services, pre-authorisations, scrutiny of bills, grievance redressal, and fraud detection to private companies and third-party administrators. This may increase administrative costs from the current 6% to 30%, as seen in the Medicare scheme of the U.S.
States Concern about Ayushman Scheme
- Telangana has not joined the Ayushman Bharat ‘as of now’ and would continue to implement its health scheme – Aarogyasri scheme that covers nearly 80 lakh families
- Odisha CM Patnaik worried that the dependence of the scheme on SECC (Socio-Economic Caste Census-2011) data will be a serious handicap in achieving the goal of near universal coverage.
- Kerala CM arguing that health is a state subject, he said that the states should be allowed to customise the programmes in health according to the respective state’s needs.
- Delhi chose to not join the Ayushman Bharat scheme as the government expressed dissatisfaction with the proposed target of 6 lakh families. Delhi has nearly 50 lakh families with 2 crore population.
Criticism of Ayushman Bharat:
- Currently, the NHPM is pushing for hospitalisation at secondary, and at tertiary-level private hospitals, while disregarding the need for eligible households to first access primary care, prior to becoming ‘a case for acute care’.
- It is important to note that without the stepping stone of primary health care, direct hospitalisation is a high-cost solution.
Problem of constraints:
- Public sector health capacities are constrained at all levels.
- Further, forward movement is feasible only through partnerships and coalitions with private sector providers.
- It is important to note that these partnerships are credible only if made accountable.
- It has been suggested that Health-care providers (public/private) should be accredited without any upper limit on the number of service providers in a given district.
Need of a holistic approach:
It is believed that one must bring together all relevant inter-sectoral action, linking health and development, so as to universalise the availability of:
- clean drinking water,
- garbage disposal,
- waste management,
- food security,
- nutrition and
- vector control.
Further, the Swachh Bharat programme must be incorporated in the PMJAY. These steps put together will reduce the disease burden.
The Way Ahead
- The National Health Protection Scheme seems to have followed the example of these state programmes and has announced that it will recruit about one lakh ‘Ayushman Mitras’ to help monitor, evaluate and implement the scheme at public and private hospitals.
- Hence these states concerns needs to be taken into account by the central government to establish cooperative among the states in order to protect the health of mass.