Highlights

Ayushman Bharat is a good scheme -needs to be made more comprehensive and self-supporting -errors in similar previous schemes, like- ‘Arogyashree’ must be avoided- ‘First cost’ payments must be called for to avoid misuse standardization of costs for procedures, implants, prosthetics and generic medicines. Primary Health centres and Digital medical consultancy must be set up and encouraged.

Quotations for Consideration

• “To freely compensate people when bad things happen to them, leads them to become more careless (Moral Hazard).” – Tim Harford
• “If you think health care is expensive now, wait till you see what it costs when it’s free!” – P. J. O’Rourke

The medical / health insurance scheme ‘Ayushman Bharat’, will only be practical over the long term if we learn from the mistakes made under the similar schemes earlier, even if they were at a much smaller level.

The ‘Arogyashree’ scheme in A.P. started very well, was received very well, but collapsed within a few years due to its shortcomings. The scheme provided free healthcare. The hospitals under the scheme saw it as the ‘Goose that lays golden eggs’, they went searching for patients and put them through unnecessary tests, scans and procedures and made money, soon draining all available financial resources.

• Every headache needed an MRI to eliminate the possibility, not probability, of a brain tumour.
• Every other symptom needed a range of additional tests and scans again to eliminate ‘possible’ not ‘probable’ ailments.

In order to prevent such misuse under the scheme, it is necessary to build in the following regulations:

1. The initial 10 percent of all charges for investigations and treatments should be made payable up front by the patient, who will then automatically control unnecessary expenditure.
2. A small (3 to 5 person) hospital committee of local NGOs and retired medical practitioners and citizens can be formed to approve waiver of the upfront charges if they find the patient really too poor to pay. This committee should also, have the right to question the tests and procedures being called for and, if necessary, call for a second opinion. This would benefit the many patients who are themselves unable to discriminate and decide on an informed consent basis.
3. A National Board to decide the rates for various procedures, for hospital stay and for medicines (mostly generic), depending on city population and type of accommodation provided.
4. The rates for private hospitals should be realistic, perhaps at twice that for comparable Government Hospitals. (See Health Care for All’).
5. To promote better care Primary Health Care centres and digital medical care and consultancy facilities should be setup
6. Encourage and include even properly validated Traditional Medical care from qualified Practioners.

Conclusion

‘Trust but verify’ is a necessary policy to follow. Make the system as self- regulating as possible. A nationwide comprehensive health insurance scheme would be best. (See – “Health Care for All).

JAI BHARAT! – JAI HIND!

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