Rather, I tried to indicate key moments that had an impact on the contemporary or future relations between the two nations. I also tried to identify international events that would also affect the relations. For more information and detail, please see the list of sources.
Considering the implementation hurdles, there are no arguments on that. But, above all these, the prospect of at least half of the population, hopefully, the poor, getting free medical care is nothing but a big revolution any country can hope for.
The UPA-government too had attempted to introduce a universal healthcare scheme when Manmohan Singh was the prime minister and had initiated discussions with expert agencies, but that remained on paper due to implementation hurdles. There are similar schemes operating on a smaller scale such as Rashtriya Swasthya Bima Yojana RSBY that began with a Rs 30, cover for beneficiaries, and also underwent a few names changes to increase the cover up to Rs one lakh.
Most recently, Odisha government introduced a healthcare scheme that resembles the contours of Ayushman Bharat.
It will be a dream coming true for the average Indian. The Global Burden of Disease study revealed in May that India ranks th among countries in terms of quality and accessibility of healthcare, even behind neighbours like China, Bangladesh, Sri Lanka and Bhutan.
Also, the government contribution to free healthcare as a percentage of GDP is almost negligible compared with most countries. Of course, the cost of launching Ayushman Bharat is one of the major hurdles in the path of its implementation. What the government has allocated in the budget for the existing scheme at Rs 2, crore is too little.
It needs to find ways to put more money on the table. This is not unachievable as 21 states have already signed up for the scheme and may have existing infrastructure. The central government needs to pay only 60 percent of the total expenses while the rest will be contributed by the state governments.
According to the consultancy expert quoted above, the average premium worked out for the scheme per family can be brought down to Rs 3, to Rs 4, if the modalities are worked out properly.
Right now, the average annual premium paid by consumers for a private healthcare scheme to avail similar cover is around Rs 10, This will also create a major disruption in the health insurance market forcing even big companies to think of low premium products to compete with the government scheme.
But, beyond the initial enthusiasm, there are major challenges the government will have to face in the rollout of Ayushman Bharat: One, identifying the right beneficiaries.
Ensuring that the scheme reaches the needy is a big challenge. Proper machinery needs to be instituted for assessment. This is critical since the benchmark the government is using right now—the census data—may be outdated to identify the income groups eligible under the scheme.
Chances of fraudulent activities using forged documents to claim the insurance amount in connivance with the hospital authorities cannot be ruled out. This is a major risk in the rollout phase.
This can be done only through periodic monitoring and proper assessment of the implementation. A group of medical experts and law enforcement officers must be deputed to make sure that hospitals indeed offer proper treatment to the poor and not compromise on the quality aspect to pocket the insurance money.
Presently, New India Assurance is the only leading state-run agency that offers health insurance products. Fourth, some state governments are reluctant to join the scheme fearing loss of political points. Ultimately, if one works out the cost-sharing, state governments that already run similar programmes are set to gain from the centre-state sharing formula.
A nationwide political consensus is essential to make the scheme effective. When Ayushman Bharat is rolled out in full scale, there will be a fiscal shock to the government to deal with.
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