Dr KK Aggarwal
Universal health coverage is the need of the hour.
Two weeks back I was in Malaysia for the CMAAO Assembly, where the Malaysian
Medical Association (MMA) spoke about their 40:40:20 scheme. The entire
population of Malaysia has been divided into three income groups: Lower income
group bracket 40%, middle income group bracket 40% and top 20 income bracket
20%. Their government has said that they would pay for and look after the lower
40% income group bracket.
That is what the Modi government has decided to
do.
Under Article 21 of the constitution of India,
right to health is a fundamental right and under Article 467 state directive
principles, it is the primary duty of the state government to provide this as
per their means and if they cannot provide, they need to enlist the private
health sector under PPP model.
Under Ayushman Bharat, the government is paying for
the insurance premium of 50 crore people. Everybody has a criticism that the
premium is too low for five lakh insurance. But the reality is it is not five
lakh insurance, the insurance is of approximately one lac as the packages have
been capped with the maximum cap being around one lakh for tertiary care
procedures. For one lakh insurance, the premium calculation is correct.
What is required is
honesty at every level in running the scheme.
Being a capped reimbursement policy, chances of
manipulations are lower except for billing one surgical procedure as two
procedures. This loophole needs to be checked.
Once the government has
divided the community into two segments the poor (under Ayushman Bharat) and
non-poor (personal insurance), every hospital also can and invariably will have
two categories in their establishments (general ward for Ayushman Bharat and
private wards for others).
In my medical college, we were taught affordable
health care under the subject low-cost healthcare and we all need to revise
this topic. For example, why should
I go for full hemogram in routine cases when the same information can be
gathered by looking at the peripheral smear and ESR.
This scheme will promote the Make in India program of the
Govt. Devices, consumables, drug, reagents and/or equipments will take
precedence and their use will increase; we
need to find out indigenous ways to manufacture these at low cost. Use of
generics will increase, use of antiseptics may increase to cut down infection
rates, which will bring down antimicrobial resistance (AMR).
The scheme will open doors for Jan Aushadhi drugs,
only essential investigations, minimum cross
referrals and promotion of day care procedures.
Being a doctor means we are different and are
considered demi Gods. Those who believe in it should do 10% subsidized
charity by choice. The
charitable rates can be reimbursed by the Ayushman Bharat schemes.
Universal health
coverage is incomplete without disease prevention and harm reduction. The
budgets for road safety, universal immunization, antenatal care, rural health,
Swachh Bharat, environmental protection, skill development, drug development,
safe water, safe soil etc. should be calculated as extension of health budget.
Harm reduction is already in the fray with
elimination of mercury by 2020, sequential phasing out of Euro 4 vehicles with
an aim to go for Euro 6, gradually reducing the air pollution parameters,
phasing out trans fats in commercial restaurants.
A major mistake of the government is not banning
tobacco from the country. The govt. is neither banning tobacco nor allowing
comparatively safer electronic cigarettes in the market giving the message that
conventional cigarettes are the best.
Among people who cannot
afford, all those covered by ESIC, CGHS, Defence (BSF, CRPF, ITBP), PSUs, State health insurance, municipal corporations etc will
automatically get excluded as they are already covered under respective
schemes.
Will casual or contractual laborers be covered under
Ayushman Bharat? Another major challenge would be
rare diseases.
Issues such as these will keep
on coming up as the scheme is being implemented.
The success of the scheme will depend on the number of
"no claims", amount of claims more than one lakh and percentage of
disorders requiring recurrent hospitalization.
Dr KK Aggarwal
Padma
Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Immediate Past National President IMA
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