Amid India’s failing healthcare system, Pradhan Mantri Jan Arogya Yojana (PMJAY) can prove to be a game changer, if implemented sincerely. Critically Evaluate. [250 words]
The recently launched, PMJAY, the largest publicly funded healthcare scheme in the world promises improvement in the secondary and tertiary healthcare standard in the country which will cover nearly 100 million families selected on the basis of the Socio-Economic and Caste Census data.
Failing healthcare system:
- Less spending on healthcare of country’s GDP, little over 1%, as against the WHO-suggestion of 4%.
- Well over 70% of health expenditure is privately financed. More than 62% is, in fact, direct out of pocket (OOP) spending by patients as against the WHO-recommended OOP ceiling of 40%.
- Less than a quarter of spending on preventive healthcare of the meager expenditure on healthcare, as compared to curative care, leading to high incidence of communicable diseases.
- Failed curative care, thanks to the:
- ill-equipped primary health centers (PHCs),
- poorly trained staffs,
- a broken referral system and crowded hospitals,
- overburdened and disgruntled medical staff,
- long treatment queues,
- supposedly free but missing drugs.
These factors pushed patients towards private providers, who now account for over 70% of healthcare provision, despite their sky-high cost for treatment. In-patient treatment in private hospitals are beyond the capacity of poor people, especially in case of catastrophic diseases.
PMJAY can be a game changer:
- Insurance cover up to ₹500,000 per family per year for in-patient secondary and tertiary treatment, which will cover over 100 million vulnerable families, accounting 500 million people, the poorest 40% of India’s population, through a network of Empanelled Health Care Providers (EHCP).
- cashless and paperless access to services for the beneficiaries at both the public and private hospitals which includes 1350 procedures covering pre and post hospitalization, diagnostics, medicines etc.
- Appointment of a National Health Authority (NHA) to roll out and coordinate the programme and Creation of 1,50,000 Health and Wellness Centres under the scheme to bring health care closer to the homes of the people.
- Creation of a cadre of front line health service professionals called Pradhan Mantri Aarogya Mitras (PMAMs) to facilitate provisions of the treatment to the beneficiaries at the hospitals.
- Absence of actuarial database to yield a probability distribution of the expected number of different health episodes requiring different treatments at varying costs.
- Fear of shrinkage of insurance coverage upon cost escalation.
- Potential surge in the cost of treatments by the private healthcare providers to enhance profit margin.
- Intended to improve secondary and tertiary healthcare, this scheme doesn’t ensure melioration of primary healthcare, with deteriorating PHCs.
Apparently, the architecture of the PMJAY programme has been carefully conceived and If successfully implemented, it could be a game changer for the 500 million or so beneficiaries who could not as yet afford any secondary or tertiary treatment.