I write for CNBC TV18 on Ayushman Bharat
In the years since liberalisation, India has added over 500 million new citizens. the country itself has gone from being an economic basket case, to being the 6th largest economy in the world at US$ 2.6 trillion. Poverty alleviation has been huge, with over 270 million people being pulled out of poverty in the last decade alone. However, one crucial aspect that could mar the India growth story is inadequate healthcare and health coverage.
Less than 1.3% of the total GDP of India was spent on healthcare. Which means that sudden illness becomes the single biggest out of pocket expense for Indian families. The situation is bad enough for the middle class, for the poor it is devastating. WHO calls poor families coping with chronic illness as a financial catastrophe; in the last decade their health care costs have increased threefold. This financial catastrophe is especially acute for poor families with older members. It is estimated that 63 million people, or 7% of the Indian population slip back into povertytrying to manage health care costs.. It is in this context that one needs to see the largest medical coverage programme in the world – Ayushman Bharat or the Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY),
Ayushman Bharat, dubbed Modicare, provides health cover to over 500 million people, or a 100 million families – for sums up to Rs 5 lakhs, for hospitalisation. In addition to the stay at the hospital, the PMJAY covers 2 days of pre-operation, 15 days of post operation, as well as the cost of medicines and diagnostics in this period. In a country where the interiors and rural areas are marked by a lack of high-end healthcare, necessitating travelling to larger medical centres with better facilities and doctors, PMJAY offers nationwide portability. This means a covered patient from a remote rural area is entitled to their health cover being valid in an empanelled speciality hospital. There is going to a boom in the healthcare sector, as 10 crore families begin to get covered. The programme that covers a population larger than that of most countries, is envisaged as the Modi Government’s flagship programme – one that they hope will bring them electoral dividends
The biggest practical hurdle the PMJAY is going to face is the acute shortage of doctors in India. As per the World Bank (2014), India has 8 physicians for every 10,000 people – the world average is 15 doctors per 10,000 people. There were just over 9.4 lakh doctors registered with the Medical Council of India, a high proportion of them concentrated in the big cities. Medical bodies are unclear as to how many of these are practising, and how many have emigrated to work outside India. some studies put the effective figure as low as 4.8 doctors per 10,000 people. It is these low numbers that are going to be an implementation hurdle.
From 19 medical colleges at the time of Independence, India now has 412 medical colleges, over 57% of which are privately owned, yet we are unable to produce the number of doctors needed to keep India healthy and ticking. It is estimated that this short supply of doctors is going to get more acute. By 2030, we are going to need 2.07 million more doctors to be able to provide adequate healthcare for all.
And, this is where the Modi government should look at innovative and disruptive steps to meet the need. One would be to increase the number of medical colleges, and teaching hospitals. But, that is going to take time. You are looking at least a decade long window before results start showing. The second is a massive push in public healthcare, upgrading and expanding the creaking system.
The third, would be to look at the primary and secondary health care sector, and borrow a page from how western countries built up their healthcare systems. They did that by allowing foreign doctors to pass an exam and practise in their country. They offered them a better opportunity that they would have in their country. And, as a result, the west scaled up fast on the backs of immigrant doctors. India should follow suit. To make sure that PMJAY is a success, we need doctors. And, the only way in which we can scale up fast enough to meet the demand for healthcare, is with migrant doctors.
Ayushman Bharat is a welcome move by the Government to provide a layer of health cover for the most vulnerable. It promises to invigorate the health care economy. However, a vital component of this is the acute shortage of doctors, and the government must plan to address this head on.
