Successful Implementation of Ayushman Bharat Digital Mission (ABDM)
& Ayushman Bharat Health Infrastructure Mission (ABHIM) will determine the success of UHC
Dr Krishna Reddy Nallamalla, President, InOrder, Regional Director, South Asia, ACCESS Health International
· There is a need for Universal health coverage (UHC)
· Need to ensure at least 80% or more people have some form of financial cover
· Robust national digital health architecture is imperative to achieve nation health goals
· Increased investment in health is not only essential but has significant economic returns.
As the world recovers from the impacts of the COVID-19 pandemic, it has become more important than ever before to have robust health infrastructure and systems to tackle any future health emergencies and need for a Universal health coverage (UHC) says Dr Krishna Reddy Nallamalla, President, InOrder, Regional Director, South Asia, ACCESS Health International
Universal health coverage (UHC) implies that every citizen should be able to access needed healthcare without financial hardships during normal times and during crisis times (health, environmental, financial, geopolitical etc). Given a choice, people should receive care when they want, where they want, and how they want. The care they receive has to be safe and effective. There is no debate on the need for UHC. We need to ensure at least 80% or more people have some form of financial cover (public, social, community-based, or private health insurance) and out-of-pocket health expenses (OOPHE) should be less than 20% of total health expenses. The percentage of the population with financial cover ranges from 15% to 85% across various States. Currently, OOPHE accounts for 55% of total health expenses. That means we have a long way to cover to reach the UHC targets by 2030. What is equally important is how UHC is achieved, and whether the cost of UHC is sustainable for the country.
Ayushman Bharat is the umbrella health reform to achieve UHC. Originally, it had two major approaches – financial protection for hospital-based care for about 100 million families falling under lower socio-economic strata under (PMJAY) coupled with free access to comprehensive primary healthcare through 150,000 health and wellness clinics. While PMJAY will improve the percentage of people with financial cover, there are estimated 500 million people without any financial cover. Informal labour and self-employed people account for bulk of these – so called ‘missing middle’. There are efforts to address the cover for the missing middle. Since the majority of health insurance schemes cover hospital-based care, OOPHE may not decrease significantly despite an increase in financial coverage. Ayushman Bharat Digital Mission (ABDM) and Ayushman Bharat Health Infrastructure Mission (ABHIM) have been announced during Covid-19 pandemic to enable the goal of UHC. These are the major steps in a long journey towards UHC. How well these get implemented will determine whether we are progressing towards the goal of UHC.
Health ID is the most critical of building blocks being developed under ABDM. Standards-based, interoperable health data linked to health ID will build personal health records (PHRs) over lifetime of a person. Patients will have the right to share their personal health data through a consent mechanism. More than the health ID, it is the robust national digital health architecture that is vital for the future success of ABDM in transforming India’s health system. In addition to Health ID, it consists of other core building blocks, namely national professional and facility registers, consent manager, health information exchanges, and personal health records. Data privacy bill will address privacy and security issues says Dr Krishna Reddy Nallamalla
Health being a State subject, the success of these national reforms will depend purely on States implementing these reforms. Almost all states have come on board to implement PMJAY and Health and Wellness Clinics. ABDM is being just rolled out across various states. Lack of fiscal space and institutional capacities may hamper the roll out plans. Since private health sector accounts for more than 50% of healthcare, governments should engage private sector in collaborative and constructive way to achieve the UHC target by all the States.
Dr Krishna Reddy Nallamalla
Regional Director, South Asia, ACCESS Health International