10 key things you must know about Modi's ambitious Ayushman Bharat scheme

Among the most important announcements that Prime Minister Narendra Modi is likely to make in his 5th speech from the ramparts of Red Fort is the announcement of the Ayushman Bharat scheme's rollout

The third floor of Delhi’s Nirman Bhavan, where the current office of Ayushman Bharat are situated, has a palpable buzz. As the day concludes, people are leaving the office here, but there is no indication that work is likely to stop anytime soon. In a few days’ time, this office is to get its own space in central Delhi’s Jeevan Bharati building, the seat of the National Health Authority.

A month since Business Standard met with Indu Bhushan, the chief executive of the world’s most ambitious healthcare scheme that is attempting to cover 40 per cent of the country’s population – roughly 500 million people – with its 1,350 packages of up to Rs 500,000 each, the sense of urgency has abated. But there is still the idea of moving ahead swiftly: The confidence is well placed.

Ayushman Bharat CEO Bhushan and his deputy Dinesh Arora, along with support staff, are still signing papers, meeting people and going about the business of putting the nuts and bolts in place. A sense of history is not lost on Bhushan. It is no secret that Prime Minister Narendra Modi’s fifth speech from the ramparts of Red Fort will be his most significant one, coming especially as it would before the general elections. The rollout of the Ayushman Bharat scheme will also be announced.

The first of the two things that Bhushan is excited about is the epidemiological data analysis, which will help decide the future policy. On his recent trip to Andhra Pradesh, it was found that people in a few districts had higher incidence of blood pressure, so the administration reduced salt intake and started offering brown rice through intervention in the public distribution system (PDS).

With enough information, it will help decide logical deployment of resources for education and training and guide future research as well.

The second, of course, is that Ayushman Bharat, by according money power on the demand side, will try to create a stronger health infrastructure in under served areas. The hope is that the private sector will move where the money is. And, so will the remaining population – the middle class does not get the same benefit, but it will at least become a collateral beneficiary.

Ayushman Bharat: At a glance

The Ayushman Bharat team is all of 50 people, 25 of whom are part of TCS and working on the software. The remaining 25 constitute the CEO, deputy CEO, the support staff and consultants on deputation.

Ayushman Bharat is an attempt to move from sectoral and segmented approach of health service delivery to a comprehensive need-based health care service. The programme aims to undertake path-breaking interventions to holistically address health (covering prevention, promotion and ambulatory care), at primary, secondary and tertiary levels. Ayushman Bharat adopts a continuum of care approach, comprising two inter-related components.

Eligible beneficiaries can avail of services across India, offering benefit of national portability. They can reach out for information, assistance, complaints and grievances through the 24x7 helpline number 14555.

Here are 10 most important facts about the Ayushman Bharat programme: 

1. The signatories: With 28 states and union territories already on board and four others – Punjab, Delhi, Maharashtra and Karnataka – signing on before August 15, the stage is set for a staggered rollout. Four states, Odisha, Telangana, Kerala and Tamil Nadu have not joined the programme.

2. The software backbone: The most significant pillar for managing the scheme, the software, has been designed by TCS and is undergoing successful field testing. The portal which will allow national portability is ready.

The software is based on the Telangana model, on which a successful health scheme, Arogyashree, has been running for the past few years. It has three modules, one for identifying the beneficiary, another for empaneling hospitals, and a third for payments to insurance companies and management of claims. In the states that have signed on, the registration of patients is taking place. “The thing with software is that you are never satisfied. You wish to change it, improve it, add features to it – it is an evolving process. Right now, it will work. It is robust and agile enough to change in replicability and scalability. ” says Bhushan. Though Telangana has not yet joined the programme, it has been supportive.

A soft rollout to check software in the beneficiary identification system was done with pilots in Haryana, Uttar Pradesh and Chhattisgarh.

3. Hospital empanelment: The work to empanel hospitals has been on, with over 7,000 of them already present on the portal. They agree to the cost structure of the packages and specifications of Ayushman Bharat.

4. Administration: The administration of Ayushman Bharat is to be through state health authorities. So far, the 28 states on board have set up their State Healt Authority. The big push now is towards staffing them by quickly appointing CEOs and support staff. “The implementation will take place and it is expected that all states that have signed up will be in the fold by September-end,” says Bhushan.

5. Ayushman Mitras: The task of training Ayushman Mitras, who will be the link between beneficiaries and the system, is key. They are the people who will identify, verify and then help beneficiaries navigate the system. They will also be processing the claims, so they need to be trained on how to use the software. Ayushman Mitras will be required 24x7, so there will be two to three of them per hospital.

There are three models of recruitment: They could be state government employees, or employees of empaneled hospitals, or employed by insurance companies. Over 100,000 jobs are to be generated, with women and trained health professionals being given a preference.

6. Financial management: Financially, most states are choosing to create trusts which will be managed by SHAs. Escrow accounts have been set up, but no state has asked for money so far. “We will have to give it a push,” says Bhushan. “In states where insurance companies have a role, they are keen to join.”

The government is confident that the claim ratio every year, based on the survey of National Health Profile, will be 2-3 per cent of the total number of insured people.

7. Structure of govt health insurance schemes: All other national health schemes and centrally supported insurance programmes, including the Rashtriya Swasthya Bima Yojana (RSBY), are to merge into Ayushman Bharat. RSBY will do so immediately, but others will merge later. There will be one overarching government scheme eventually.

8. The role of primary health centres: Primary health centres are expected to participate for follow-ups and management of diseases.

9. No copayment: Unlike almost universal health coverage in China which involves copayment, the population covered by the scheme in India will not be expected to pay anything at all. That is even as a copayment system, albeit a small one, could reduce moral burden and give the payer more confidence to demand service. “To begin with, I am okay with taking on the complete cost of treatment,” says Bhushan.

10. Key jobs after the scheme’s launch: Among the most important things that will need to be done after the rollout of the Ayushman Bharat scheme will be redress of complaints, training, constant upgrade of software to respond to changes, and checking malpractices.