Can India look into the US government’s healthcare insurance as a case study to take its Ayushman Bharat to globally accepted delivery parameters?
Diplomatic circles and thinks tanks in Washington DC are abuzz; so are the official circles in Raisina Hills. The guessing game is on, to get an idea of the itinerary of the high-voltage official engagements between US President Joe Biden and Indian Prime Minister Narendra Modi, who is on his first “official engagement” to the US in nine years.
Last week, as we were discussing what the possible agendas could be for the bilateral talks and the photo-ops other than the usual defence, security, Quad, Indo-Pacific, and not to miss, how to contain China jointly, an interesting thought came about on how India can leverage the health diplomacy it initiated with the US during the life-threatening Covid-19 pandemic—something it might consider taking to the next level. Indian and American companies have been at war over health insurance, something the former resisted strongly while the latter wants to tap into the large unexplored Indian population, which is predominantly uninsured.
This is just coincidental. PM Modi must be gearing up with his best one-liners that he would have kept for this occasion, and his speeches for the diaspora, which he is best known globally and for the Indians abroad. The year 2023 also marks the five years of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), the Bharatiya Janata Party’s flagship healthcare insurance scheme. Committed to providing Rs 5 lakh coverage to over 10 crore people, Ayushman Bharat seeks a critical review and accountability, as the national health care insurance scheme has left gaps to address, ensuring that the grievance redressal mechanism comes out of unending public complaints.
Can India look into the US government’s healthcare insurance as a case study to take its Ayushman Bharat to globally accepted delivery parameters? The upcoming Modi visit offers a perfect platform for Indian officials to initiate a dialogue on best insurance practices that can aid good healthcare delivery and patient satisfaction in India. The Affordable Care Act, colloquially known as Obamacare, is named after US President Barack Obama, who signed it in 2010 and made it a landmark federal statute. It is not devoid of shortcomings, including inequity in delivery and lack of uniform-level healthcare facilities at all hospitals across North America. The latter is a critical limitation pointed out in India’s Ayushman Bharat’s delivery and patients’ satisfaction responses after five years of its existence. Official health sources have confirmed public complaints and frustration for the lack of private care facilities as entitled in the insurance, and the same was witnessed in large cases during the Covid-19 pandemic health crisis. Inequity in access is also a serious issue, especially for the poor who suffer from serious ailments. Many treatments are not listed under the Ayushman Bharat health insurance scheme, and that adds to the patient’s frustration.
Setting commercial frictions and profit-centric agenda aside, both countries can always learn and share knowledge as the two nations worked during the Covid-19 pandemic. Experts linked to India-US diplomacy and the Indian diaspora advocate a strong India-US dialogue to strengthen the Indian insurance sector.
President and CEO of US-India Strategic Partnership Forum (USISPF), Mukesh Aghi told The Sunday Guardian: “While the US health insurance sector is very politically charged, there is innovation in MedTech. We have seen the United States and India collaborate during the pandemic, and through the Quad prioritize the need for safe and efficient vaccine delivery to countries in the Global South and the Indo-Pacific region. India’s stature as a vaccine and pharmaceutical manufacturing hub and the American pharma industry, logistics, and innovation in MedTech makes it ripe to have a focused US-India healthcare dialogue. The pandemic showed that trade differences can be worked out by focusing on mutually shared interests and leveraging each other’s strengths and prioritizing health and human security.”
Added Katherine Hadda, a career diplomat and now a Visiting Fellow at the Center for Strategic and International Studies (CSIS): “My own observation is that there are models of public and private insurance in the US that might be worth considering as Ayushman Bharat expands its mission. A government-managed Medicare-type system that specifically addresses the needs of older patients is one notable example. Many Medicare participants also carry private ‘gap insurance’ that covers care not covered by Medicare itself. This kind of public/private hybrid might also be a good solution for India.”
Hadda, who has also served as US Consul General in Hyderabad, was all praise for Ayushman Bharat, but it needs to meet the upcoming healthcare demands, and that will require upgradation in its policy execution. Hadda told this newspaper: “Ayushman Bharat has made impressive gains in the scope of care, especially since Covid. Its publicly funded, privately provided care can serve as a model for other public health systems globally. It is, however, focused on emergency care. As India’s population continues to skew older, a greater focus on preventative care will be needed to better serve patients and keep costs down. US insurance companies can be a model here, as most now offer reduced premiums and/or other incentives for to encourage participants to maintain healthier lifestyles, such as managing NCDs, getting vaccines, exercising, and adopting better diets.”
A business and trade expert, Aghi sees the health insurance sector becoming a nearly $25 billion market by 2028. “However, given the large population, several people are dependent on the government and schemes such as Ayushman Bharat, which covers vast parts of the country, from the tiniest most remote villages and serving our most vulnerable population. Rising medical costs will lead to increased healthcare spending and more insurance players in the market,” says Aghi adding, “however, it will also cost the exchequer, and hence the pandemic showed both India’s ability to produce indigenous cost-effective vaccines and the scale of mass vaccinations. To protect our most vulnerable and underprivileged parts of the country, the focus has to be on affordable healthcare and cost-beneficial insurance schemes.”
All this a herculean task, says Aghi, but added that “the pandemic showed India’s logistics and medical prowess in this regard.”
Vice President of the American Association of Physicians of Indian Origin (AAPI), Dr Satheesh Kathula cited a case in India to ring the alarm bell to balance critical ailments and rising treatment costs. Dr Kathula, who is a clinical professor of medicine in Dayton, Ohio, toldThe Sunday Guardian, “About 20 years ago, my cousin was diagnosed with chronic myeloid leukemia, which is a curable blood cancer with oral medication. Unfortunately, the cost of the drug for a month was four times his monthly income. I was able to get the drug in India, free of cost through a foundation. He is alive and doing well after 20 years. How many people can afford these expensive drugs or even some basic ones? I have heard stories of people dying because they can’t afford to buy insulin for diabetes.”
Dr Kathula added: “Some state governments are offering ‘ArogyaSree’, which covers the poor with a certain level of income and this has been a blessing for lakhs of people, though it has some limitations. Now, we have Ayushman Bharat. Potential solutions lie in expanding Ayushman Bharat and state schemes to include middle and upper middle-class people, even if there is some affordable premium. We must encourage private insurance if they don’t qualify for government schemes, and simultaneously allow private insurance companies, even if they are foreign, to compete to provide affordable premiums.”
Aghi stressed the safety and quality of healthcare will self-mitigate the need for redressal and grievance. “India is a price-sensitive market and hence, healthcare must be made cost-effective”, Aghi added.
Is the upcoming visit a perfect window to expand the knowledge partnership and expertise sharing in insurance between India and the US? A first-hand feedback of US health insurance working from its officials, and talking with the Indian American diaspora, including the Indian origin doctors in the US about their experiences will open more avenues for dialogue and partnership to strengthen India’s health insurance sector. There are gaps in the US health insurance too, including the unending inequity grievances. But, at least, one doesn’t die because of non-payment by the insurance here. India, with its growing ageing population, and the poor and underserved in remote areas, have a challenge at hand that seeks to address it beyond a mere political manifesto. It demands a ground-zero social prescription.
Maneesh Pandeya is a Fulbright Professor and a Ph.D. Scholar at Howard University in Washington DC. Dr Manoj Sharma is Professor & Chair of the Social and Behavioral Health Department at the University of Nevada, Las Vegas.