By addressing the barriers to healthcare access and affordability, Ayushman Bharat strives to improve health and reduce health inequalities

Ayushman Bharat, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a pioneering healthcare scheme launched by the Government of India in September 2018. The program aims to provide health insurance coverage to economically vulnerable individuals and families, offering them financial protection against catastrophic health expenditures. Ayushman Bharat Card (ABC) is a significant step towards achieving universal health coverage in India and improving access to quality healthcare services. This policy of the union government has shown her eagerness to provide health security to the weaker sections of the society following models of successful economies where such programs have delivered attractive outcomes.

Current State of Evidence:

ABC provides Health Insurance Coverage to over 500 million individuals from low-income households. Beneficiaries receive a health card that enables them to access a wide range of secondary and tertiary healthcare services at empanelled public and private hospitals. It strives to provide Financial Protection to vulnerable populations from the burden of high healthcare costs. Evidence suggests that catastrophic health expenditures can push households into poverty. ABC significantly reduces out-of-pocket expenses for hospitalizations thereby protecting families from financial hardships and preventing them from falling into debt traps. ABC ensures a broad network of Empaneled Hospitals, both public and private, across the country. As of now, around 29000 hospitals have been empanelled under the scheme. This network expansion has been particularly significant in rural and underserved areas.

ABC provides Coverage for Pre-Existing Conditions including chronic diseases. By providing access to affordable care for conditions like diabetes, cardiovascular diseases, and cancer, ABC improves disease management, enhances health outcomes, and reduces long-term healthcare costs. The ABC program has made significant progress in Expanding Health Coverage across India. As of now, over 23.40 Crore beneficiaries have been enrolled. This expansion has improved access to healthcare services for millions of individuals who were previously uninsured or lacked the financial means to afford quality care. ABC has leveraged Technology-Driven Approach to facilitate data collection and analysis, enabling evidence-based decision-making.

Evidence-based comparison

It’s implied that ABC draws inspiration from countries where similar policies have proven their potential. To better understand the strengths and limitations of ABC, it is valuable to compare it with foreign healthcare programs.

That gives insights into different approaches to achieving universal healthcare coverage and assesses the potential effectiveness of ABC within a global context. This evidence-based comparison will explore similar programs in various countries, considering factors such as program scope, implementation strategies & funding mechanisms.

Talking of the USA at the very outset, Affordable Care Act (ACA) aims to expand access to healthcare coverage and reduce costs for Americans. It primarily focuses on reducing the number of uninsured individuals and improving the quality of healthcare services. It expanded Medicaid eligibility for low-income individuals and provided subsidies to help make insurance more affordable.

In the United Kingdom, National Health Service (NHS) provides comprehensive healthcare services, including hospital care, general practitioner services, and pharmaceuticals, to all residents of the United Kingdom.  In Germany, Statutory Health Insurance,  GKV, has a dual healthcare system that consists of statutory health insurance (GKV) and private health insurance.

 Future Prospects:

Strengthening Primary Healthcare: By focusing on preventive care, early intervention, and primary healthcare infrastructure, the program can improve health outcomes and reduce the need for expensive hospitalizations.

Enhancing Quality of Care: Empanelment of more accredited hospitals, implementing robust quality assurance mechanisms, and monitoring patient satisfaction can help enhance the overall quality of care delivered through ABC.

Addressing Regional Disparities: Future efforts should concentrate on bridging the gaps by targeting underserved regions, incentivizing private sector participation, and improving the reach of healthcare services to marginalized populations.

Ayushman Card has emerged as a game-changer in India by addressing the barriers to healthcare access and affordability

(Authors are the President and Secretary of the Foundation for Evidence-based Development in India (FEDI) respectively. Views expressed are personal)