Ayushman Bharat gets more execution teeth, CEO hopes to iron out pending challenges in 2019

The New Year started on a good note for the CEO of Ayushman Bharat mission, Indu Bhushan. On 2nd January, the government in a Cabinet meeting dissolved the National Health Agency that had been created to implement the scheme, and upgraded it to an authority-National Health Authority. According to Bhushan, this was done to give it greater autonomy and more powers. In his first interview after the executive order and the end of the first 100 days of the scheme, he lists out the achievements so far of the scheme launched in September, 2018 and the challenges that the scheme will need to deal with in 2019. In February last year, Union finance minister Arun Jaitley, while presenting the general budget 2018-19 in Parliament announced the Ayushman Bharat scheme, a national health protection scheme to cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries), providing coverage of up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. Here are excerpts from the interview.

Business Today: How has converting NHA into an authority made a difference? Is it as an executive order?

Indu Bhushan: This gives greater autonomy and more power to implement the scheme. This will ensure faster decision-making. Earlier, there were several levels of decision-makers- there was a governing board, a council and the ministry. Now, our mandate has been very clearly specified. There is only one board (with representation from state governments and with two domain experts from fields such as insurance, economics, public health) and we directly report to the minister and this will help in faster decision-making. In the short term, it is through an executive order but in due course, it will have to be taken to the Parliament through a bill but in the meantime, we can rely on the executive order to work. This is how many other agencies like the Securities Exchange Board of India (SEBI) and UIDAI (Unique Identification Authority of India) were established initially through an executive order and later confirmed through a Parliamentary act.

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BT: How do you look back at 2018 and what are your expectations in 2019?

Bhushan: The year 2018 was tremendous for us as we could roll out Ayushman Bharat although some people were sceptical earlier whether it could be done in such a short time. Not only could was it rolled out, the initial momentum as also been really well without any glitches in terms of IT or in any basic design of the scheme. There are off course challenges when you come to a scheme like this with its scale and ambition.

In 2019, we hope to deepen the scheme and hope that that the three remaining states that have not yet joined - Delhi, Telangana and Odisha - will also come on board. We would like them to join largely for the portability issues because Delhi is a major centre for health, especially for tertiary care and so is Hyderabad. And, Odisha is a large state with lot of Oriya people outside of the state. If the three states also join, then it will truly be one nation, one scheme. (By portability, he means, if you are a patient from say Bihar, you need not be restricted to getting treated only there and you could get the treatment in any part of the country. In short, the benefits are portable).

BT: But then, given the scale and nature of the scheme and the various issues involved in rolling it out, what do you see as the major challenges?

Bhushan: There are several challenges that we see. One challenge is to see ensure fraud and abuse can be minimised and ideally prevented, all together. (Read: these could be either over diagnosis by hospitals or over charging by them and these could be sorted out by software and alert systems). The other challenge is about the quality of services. How to maintain and ensure quality of services because it is not only about numbers? In the health field, it is often also difficult to quantify quality because of the asymmetric information--the provider has much more information than the patient that come from the poorest 40 per cent strata of our society. Also ensuring that they get the quality care, which is due to them. The other challenge is ensuring that we get the best of the private sector, to be part of the scheme. There is a concern about prices and the contract package rates among some hospitals and bringing them on board and encouraging them to also expand beyond the metropolitan regions, will be another challenge.

But then, once you start the scheme and have the momentum going, all these issues will be tacked one by one.

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BT: These are early days perhaps but still what do you see as Ayushman Bharat's achievements so far and what you would want to build on?

Bhushan: We have a long way to go but then getting 33 states and union territories on board out of a total of 36 has not been a small achievement. Second achievement is the national portability that has been made possible. Close to 2000 people have benefited so far from this. This not a small achievement because take the example of China. It has a scheme running for 12 years but they still do not have a national portability. There are logistic challenges as to who pays and how does one identify the beneficiary and the IT needed for it. All has to be in place and we could get to that with four months of planning.

Plus, in terms of patients who have benefited overall from the scheme, it is 7 lakh since the launch of the scheme last September 23rd and more than 16,000 hospitals have been empanelled so far. My personal goal is to get to 25,000 of them by the end of this year.