Ayushman Bharat Pradhan Mantri Jan Arogya Yojana has been the most talked about health sector scheme in recent times. Given the scale and ambition of the scheme with its target group larger than the combined population of Canada, the United States and Mexico it is not surprising. As could be expected, the scheme has a large number of supporters who are highly inspired by its vision and promise. There are also groups of detractors who are concerned that the scheme either seeks to address a wrong problem or provide a wrong solution even if it aims to address the right problem. I address the ten most common concerns raised.
The most common refrain against AB-PMJAY is that the government should focus more on public health issues and preventive and promotive care. While it is correct that prevention is better than cure, in real life both are needed. The policy challenge is not prevention vs cure but how to provide both prevention and cure. What can poor people be expected to do when faced with catastrophic health expenditure Usually, they forego treatment and hope for the best, or borrow heavily, or sell whatever assets they have, pushing them deeper into poverty. A welfare state ought to focus on curative aspects of in-patient care.
Some people argue that the government should not use its limited resources for support services through the private sector. The private sector plays a critical role in health sector. We will need to leverage the capacity, financing, skills and energy of the private sector to provide services to millions of people who have hitherto not had any access to these quality services. Strategically tapping private sector services might be a more efficient, effective and affordable solution.
There is a concern that the private sector is poorly regulated and therefore the government should first focus on strengthening regulations and ensuring they are enforced. Purchaser of health services can strengthen the regulations due to their strong financial leverage over the private sector. Since AB-PMJAY purchases health services for more than 50 crore population, it can set up prices effectively influence quality of health services incentivise hospitals to improve quality with differential rates and enforce electronic data sharing by private hospitals.
Some point out that government services are free, what then is the value addition by AB-PMJAY While most states seek to provide free healthcare through government hospitals, in reality, patients still have to spend a lot from their pocket. In many cases, they have to get the diagnostic services, drugs and implants from outside as they are often not available in the hospitals. All public tertiary care hospitals charge for major services such as heart operations, cancer treatment, and knee replacements.
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