How India’s public health insurance programme is navigating the Covid-19 crisis

Health for all.
Health for all.
Image: REUTERS/Sunil Kataria
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With the raging coronavirus outbreak in India come mounting hospital bills.

This is considerably difficult in a country where only 20% of the population has health insurance coverage. Consequently, Indians pay the most out of their pockets globally for accessing healthcare services.

But India’s public health insurance coverage for the impoverished could help alleviate some of this financial burden. The Ayushman Bharat scheme, also known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), provides a health cover of up to Rs5 lakh ($6,628) for 100 million families across the country.

Though currently limited to less than half of India’s 1.3 billion population, the programme eventually wants to include those that currently do not qualify for benefits. “There is a large group that is missing out, and hopefully…we should be getting that group also covered, even if it means getting some financial contribution from them,” Indu Bhushan, CEO of the National Health Authority (the agency that presides over the scheme), told Quartz.

He also spoke about the NHA’s coronavirus response, the goal to reduce India’s out-of-pocket expenditure on healthcare, and making PM-JAY beneficiaries more aware of their entitlements. Edited excerpts:

What has been Ayushman Bharat’s role during the coronavirus outbreak in India?

Indu Bhushan
Indu Bhushan
Image: National Health Authority

We are managing the call centre for the 1075 helpline of the health ministry. We field about 30,000 to 40,000 calls every day in terms of providing information. Secondly, we now have a big database of citizens. This database also shows us who are the high-risk people, the elderly, those who have co-morbid conditions, etc. We have made 700,000 calls to such high-risk people. Of those, we follow up with anyone who has Covid-19-like symptoms. We ask doctors to call them to ensure they get the right information and treatment. If they need testing, treatment, or isolation, we manage that.

Then, with Aarogya Setu, all the people who report having Covid-19 like symptoms and are in categories of having been in direct contact with a Covid-19 patient are called first. We try to ensure that the symptoms they are reporting are indeed present. Then we connect them with doctors and offer telemedicine and ensure follow-up actions.

We have also expanded our empanelment (of private hospitals) because we know that we need more hospitals, not only for Covid-19 but also for non-coronavirus cases. As many hospitals have converted themselves into dedicated Covid-19 hospitals, a lot of critical activities like dialysis and chemotherapy still need to be done and we need more hospitals.

So in the past month-and-a-half, we have actually impanelled more than 1,000 new hospitals to take care of such people.

Are people using the insurance cover for testing and treatment of Covid-19?

We have prepared packages and most of the states have started providing testing and treatment under PM-JAY. So far, the caseload was not that much and that’s why much of the response was centered on public health facilities. But as the surge is taking place, we’ll need more and more private sector participation.

Has the pandemic derailed your plans? What has changed?

The pandemic has derailed the whole world. So, it would be unrealistic to expect that all programmes will continue as they were. But it has also given us some pause in terms of how we should be reshaping the programme and turn a bigger focus, on say, infection prevention and control.

Also important for us is looking at co-morbid conditions because most of the people dying have these issues. So treatment for those conditions and ensuring that we prevent non-communicable diseases is important. The importance of addressing those, especially their effect on the poor, is the big lesson.

Another big lesson is about the portability of PM-JAY. As we’ve seen a lot of migrant workers are going from their place of work to the place of home. It is an opportunity for us to educate them and run a campaign, which we are going to start very soon. They need to know that they can access these benefits even after they go back to their place of work.

This has given us an opportunity to popularise Ayushman Bharat because if all these migrant workers didn’t know about it now they would.

For a layperson seeking medical treatment, there is generally a web of different schemes and healthcare assistance they need to navigate. What will it take for people to have consistent, single-window access to health schemes?

We have been thinking about this. This was also the focus of Niti Aayog’s report on healthcare, which lays emphasis on the huge fragmentation of different schemes. Sometimes these schemes overlap and sometimes there are groups of people that are left out. In our five-year vision statement for the NHA, we also see in the future all different schemes converging using the same kind of platform and protocols.

If you look at it from the hospital’s perspective, they have to use different forms, claims, and  approaches to seek payment from different agencies. And, from the government’s side, you’re paying different rates for the same disease for different schemes. I think this doesn’t make sense. So, having that kind of convergence is the goal, and hopefully, we should achieve that.

Right now our focus is on consolidating the current scheme and ensuring that it is deepened, and then we move on to what we would call the second-generation reforms in health financing later.

There was initial resistance to implement Ayushman Bharat in Odisha, Telangana, West Bengal, and Delhi. Has that now been settled?

They are still holding out, though Delhi has decided to join. I hope this epidemic also encourages others to join as well. We hope we can soon have nationwide coverage. I don’t want to talk about political angle, so I will stick to the technical perspective. There is no reason for any of the states for not joining the scheme. It’s a win-win situation because if they join the scheme, they will get resources from us. They’ll get knowledge, other best practices, and capacity-building support. People are going to be covered not only for treatment, in their states but also outside because we have this portability in all these states. All these states have people who go outside for work.

Their hospitals, too, are going to gain because they will get more business. People will be coming from outside the state and demand will quickly improve, and in general, the health system will improve. So it’s a no-brainer, in my view, to join the scheme.

India continues to be a country with one of the world’s highest out-of-pocket expenditures on health. Why are we not improving on that parameter?

This was a primary reason for putting the Ayushman Bharat scheme in place. Having said that, we should not expect that change immediately. It will take some time; other countries have taken a decade or so to reduce this burden of these costs on their citizens.