Ayushman Bharat, launched by Prime Minister Narendra Modi in Ranchi, is grand in vision and essential for a country like India. The rushed beginning will necessarily be patchy and the right level of funding will be identified over time.
It must build on the experience of earlier attempts to provide healthcare cover such as the National Rural Health Mission and offer flexibility for state-level experimentation.
Higher government spending on health, barely 1% of GDP at present, is welcome. Action on multiple fronts is needed to make PM-JAY work. One task is to create the medical manpower needed to serve 130 crore people. Legally empowering nurses to undertake certain tasks in treatment and anaesthesia would be part of that.
PM-JAY allows states to choose between insurance and trust models. Ideally, India should move to a system of accountable care to better align the incentives of the payer, provider and the patient. This would bring down the cost of healthcare.
The incentives for care providers and insurance companies are out of sync in a traditional insurance model: care providers seek to maximise their take, jacking up expenditure, especially on investigations and avoidable procedures and medication while insurance seeks to minimise its payout.
A far better way to align incentives is to pay the care provider a per-capita fee to provide care to a defined group. The cost it would take to keep a person healthy and treat her if she falls ill can be worked out using the actuarial expertise that is adopted by insurance companies. Of course, sound regulation must ensure that the provider does not economise on treatment at the expense of the patient.
The government can draw upon the state-level schemes that have been running under the National Health Mission with varying degree of success. The huge health data that would be generated through PM-JAY must be protected and anonymized versions made available for training artificial intelligence algorithms and improving therapeutic efficiency. Reform must also focus on primary and preventive healthcare.