Dr A S Bhatia
26th Of December 2020 will be remembered in the medical history of Jammu and Kashmir as the Golden Day when Prime Minister of the Country Narendra Damodardas Modi launched Ayushman Bharat Jan Arogya Yojana (AB-PMJAY) SEHAT via video conferencing to extend health insurance coverage to all residents of J&K. As per the official hand out, this scheme will ensure universal Health coverage and focus on providing financial risk protection and ensuring quality and affordable essential health services to all individuals and communities. AB -PMJAY assumes more significance in the present scenario when the cost of medical care has become very high especially for those suffering from life threatening diseases and requiring repeated hospitalization like cancer patients. Many of these patients never recover from the economic trauma and very sad to note that many of them had to sell their lands and many villagers were forced to sell their domestic animals to bear the sky roaring cost of treatment. The plight of poor and elderly in getting medical treatment has been very well described by Rosemary Stevens, an American historian and sociologist at the university of Pennsylvania who wrote that, ”In the early 1960s, the choices for uninsured elderly patients needing hospital service were to spend their savings, rely on funding from their children, seek welfare (and the social stigma this carried), hope for Charity from the hospitals or avoid care altogether” That is a miserable emotional condition for anyone who had lived his life with dignity. But here in Jammu and Kashmir with the launch of this health guarantee the “AB -PMJAY, scheme will be able to absorb the blow and will go a long way in preventing the catastrophic economic effect caused by unexpected medical expenses”.
In order to get the best out of the scheme, there is urgent need to strengthen the private health care sector in the union territory, which is still in its infancy stage, forcing many of our patients to flee to the neighboring states to get the high tech Medicare. The present existing private health care infrastructure of the UT is not able to cope up with the emergency medical or surgical cases. These heath care stake holders in the private set up are so far playing a very safe game. It is a horrible experience for anyone, even for those who can afford the medical expenses, when they are referred to Government hospitals, in case of deterioration of their health during treatment in a private nursing home. The important aspect is total absence of private emergency services in the UT. It does not matter , what is your economic status, what is your political status, what is your buraucratic status, whether you are a chief secretary, an MP, an ex minister or chief minister , it doesn’t matter whether you are poor or rich , You, as the resident of Jammu and Kashmir have no choice in case of medical emergency rather than to go to the Emergency of a Government hospital and wait for the hour till your condition becomes stable and then get yourself shifted to higher centers outside the union territory for high end Medicare.
The Covid pandemic has also given us a wakeup alarm to focus on strengthening the existing health care system. It has proved beyond doubt that the present Private health care infrastructure is far behind to fight against a pandemic. Ironically there was total absence of private stakeholder in this fight against the Covid pandemic. Despite of many draw backs the public health care system with its weak resources have proved themselves in blunting the effect of pandemic but ironically the private set up which constitutes about 70% of health care system in the country has a negligible role during this crisis. As many may not know, privatization of government district hospitals was on cards a few months back, but on contrary several state governments have moved temporarily to “nationalize” the private health sectors to overcome the corona pandemic. In our UT also, the government had to take over many private nursing homes to accommodate the covid patients. Even the corporate hospitals of the UT failed miserably in contributing to rein the pandemic. I was surprised to learn that one of the reputed healthcare centers was giving the results of covid tests after three days after getting it done from a private lab from Delhi!! With such type of private set up, I really wonder if the goal of Mr Narendra Modi will be fulfilled! It is not mandatory now, with the launch of this wonderful people friendly scheme, to force a patient to get treated from government system. And this is going to decrease the burden on already overburdened and overstretched public health care system. To make the scheme really successful, there is need to call the big names to invest in the UT, bring them to the door steps of the poor with the financial guarantee of AB-PMJAY, so that the real benefit is given to the patient at grass root level.
Another Important thing which the policy makers and the enforcement agencies need is to be very vigilant in preventing the misuse of the scheme by the private sector. The private sector needs to be regulated to play a greater public role like it is being forced to play at this time of pandemic although reluctantly. There is urgent need for developing an effective mechanism to monitor the health care delivery system by the private parties. Lack of accountability is plaguing the private health care delivery system. Hence it becomes imperative to develop State health advisory committee with experts from the different field of medicine, business management, NGO/ individuals involved in Right to information act, to monitor the working of private stakeholders. A WHO survey of nine countries , including India, China, Japan, Nepal and Sri Lanka during 2007-08, reported the proportion of caesarian sections births had gone up beyond the recommended level of 15 percent- not ” because of an immediate medical emergency for it but due to financial gains.
Therefore the safety of patients in private sector hospital needs to be monitored by high powered health committee, unless it is found to be adversely affected. Unnecessary surgeries for the removal of fibroids and gall bladder and deliveries through caesarian sections are to be monitored in upcoming big corporate hospitals, if any.
With the rolling down of this dream project of PM Narendra Modi, it is again important to think the question of banning the private practice by government Doctors. As the experience of this pandemic has revealed it were only government doctors who came to the rescue of covid patients and the Government. All private clinicians of the region closed their clinics and nursing homes for the fear of corona, but the government doctors took the fight on their shoulders and played their role very well. Hence a comprehensive policy needs to be evolved regarding their private practice rather than thinking of putting a blanket ban on their practice!
During the launch of the AB-PMJAY, Narendra Modi interacted with the beneficiaries of Ayushman Bharat scheme and it was heart rendering to see one of the cancer patient, in response to PM remark that your Nasseeb (Destiny) has done you a favour and to the utter surprise of everyone the poor cancer patient, a driver by profession with tears in his eyes said, “Sir Scheme ( Ayushman Bharat) Nahi Hoti, Toh Naseeb Kaya Karta!!(If the scheme had not existed, what the destiny could have done!). Very true it is the political will which can bring the smile and relief to its citizens and it’s the duty of scheme enforcing agencies to see that the project is implemented in letter and sprit and the actual benefit is brought to the poor people for which the scheme was launched. The beginning has been done by the Government of India. Now it is for the implementing agencies to see that all benefits of AB-PMJAY -SEHAT are expressed at grass root levels or otherwise as Mirza Ghalib said,
“Mulakate jaroori hai agar rishte bachane hai,
Laga kar bhool jane se to poudhe bhi sukh jate hai”
(The author is Vice President Indian Academy of Biomedical Sciences, India and Professor and Head Department of Biochemistry, Government Medical College Jammu.)
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