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Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY): Hope for Millions and Exciting New Prospects for Neuro-Healthcare
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.271284
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY) was launched on 23rd September 2018, by the Prime Minister at Ranchi. By providing health assurance cover for more than half a billion people in one go, it has emerged as the biggest government funded healthcare scheme on the planet. But then, it was about time. Despite India having the largest number of stakeholders contributing toward the human footprint around the globe, there was no national health protection scheme available for most of the population. There was of course private insurance and other limited government aided health insurance schemes like CGHS and ESI etc. Thus, on the Independence Day in 2018, the Prime Minister announced AB PMJAY. The scheme aiming for the poor and vulnerable families in urban and rural India assures an annual health cover of Rs. 5 Lakh to each of the enlisted families for hospitalization in secondary and tertiary levels. The existing Rashtriya Swasthya Bima Yojna, started by then UPA (United Progressive Alliance) government has been incorporated into AB PMJAY. To get maximum number of beneficiaries, no criterion has been fixed for the size of the family or the age of members. Since its launch in September 2018, there have been over 5 million hospitalizations in over 18,000 empanelled hospitals throughout the country. For neurology and neurosurgery, the scheme has several potential benefits. Practically all the significant neuromorbidities requiring secondary and tertiary care have been covered. PMJAY covers meningitis, stroke as well as brain tumors and epilepsy surgery. This means that for 40% Indians, there should be no worry on account of such diseases. Care can be accessed from both private and public health care facilities. Such strategy would help to create an access to uniform healthcare both for private and public health sector hospitals. There are several direct and indirect benefits to this. Firstly, it would serve to enhance neurosciences health care in all hospitals by making treatment more affordable. Secondly, an automatic increase in the number of patients with neurological diseases would again serve to allow the hospital to invest in more technology for neuro care and in long term, of course would serve to create better expertise. This in due course would also attract the paying patients. Thirdly, it would contribute towards creation of epidemiological database for neurological diseases. The long term implications of this scheme are immense. It aims to enhance access to quality healthcare and at the same time avert out of pocket expenses. This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus leading to improvement nation's wellbeing and productivity as also poverty reduction. Like any new mega-scheme, there have been occasional instances of infidelity. The National Health Authority (NHA) has de-empanelled more than 100 hospitals for irregularities to deter others. Comprehensive systems to prevent, detect and deter fraud have been introduced. Schemes like Ayushman Bharat can only function best when the citizens understand their social responsibility and collectively demonstrate honest and civil behaviour. It is also up to all the citizens to enable the beneficiaries to access care to which they are entitled. It must benefit the people who need it most. One must understand that unlike mechanical sciences, health care development may not necessary follow a linear curve, i.e., models working in a microscopic environment may not necessary function in the same manner on a large scale. When AB-PMJAY expands to involve greater number of stake holders, the very dynamics of health economics may change. India will potentially hold access to the most powerful weapon on the planet, the big data, the very tools which have created IT giants like Google and Microsoft. This huge data base may hold secrets to create exciting new AI algorithms which themselves will provide useful insights towards treatment, epidemiology and prevention of these diseases. Neurosciences fraternity can play an important role in serving our people and advancing the profession by three actions: 1. Help create massive awareness about the entitlement of the potential beneficiaries. Too many of them have yet to connect to the system. 2. Help develop evidence-based treatment guidelines to standardize care in the country. The treatment algorithms can be weaved into the PMJAY management system. 3. Help train many more neurosciences healthcare providers. We need more than 5 times the existing number of neurologists and neurosurgeons. How can a rapid capacity increase be accomplished through the DM/MCh and DNB/FNB systems? Each one of you, in public or private sector, must not only be a provider but also a teacher. Are you doing enough in this regard? Lastly, let us also remember that Ayushman Bharat also encompasses Comprehensive Primary Health Care through Health and Wellness centres (HWCs), as its second pillar. We urgently need to incorporate home and HWC -based primary care for conditions such as epilepsy, dementia and Parkinson's Disease. Hence, I appeal to you to create a working group on Primary Neuro Healthcare to develop such a model, and through a research collaboration demonstrate its implementation as a multi-site pilot within a year. This would be a pioneering contribution of the Indian neurosciences fraternity for India and for the world. The following article is a personal opinion.
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