THE HINDU Editorial Vocabulary - September 25, 2018 - Topic 1

Long road ahead: on Ayushman Bharat scheme

Ayushman Bharat has been rolled out as a health protection scheme that will provide guaranteed access to treatment that is free at the point of delivery to about 40% of the population selected on the basis of censused socio-economic indicators. It is the essential first step on the road to universal health coverage, although it has been launched by the NDA government quite late in its term, possibly with an eye on the 2019 general election. Since the Centre has announced that 10.74 crore families identified through Socio-Economic Caste Census data will be given an annual Rs.5 lakh cover under the Pradhan Mantri Jan Arogya Yojana (the insurance component of the scheme), the question of eligibility appears settled. 

But the late start makes it virtually impossible for all those who are technically insured to avail of the services that state agencies must make available, within a reasonable time-frame. And, the allocation of just Rs.2,000 crore during the current year to the PMJAY cannot provide the promised cover to the large population sought to be included. Not all States and Union Territories are in a position to raise their own share, and a few have not even joined the scheme. The challenge of funding, therefore, remains. And without adequate budgetary commitments, the implications of pooling the financial risk for such a large segment of the population through insurers or state-run trusts or societies make the outcomes uncertain.

Guaranteeing health-care access using private or public facilities presumes tight cost control. In the case of the PMJAY, this is to be achieved using defined treatment packages for which rates are prescribed. Costs are a contested area between the care-providers and the Centre, and many for-profit hospitals see the government’s proposals as unviable. In the absence of adequate preparation, the Ayushman Bharat administration is talking of a rate review. More importantly, a lot of time has been lost in the NDA government’s tenure, when State governments should have been persuaded to regulate the hospital sector under the Clinical Establishments (Registration and Regulation) Act, which dates back to 2010. The law broadly provides for standardisation of facilities and reasonable rates for procedures. Apprehensions of fraud have prompted Ayushman Bharat administrators to announce that some key treatments should be availed through public sector institutions. But public facilities have been neglected for long. Going forward, there are some clear imperatives. It is essential to reduce the pressure on secondary and tertiary hospitals for expensive treatments by investing in preventive and primary care facilities. Here, the 150,000 health and wellness centres of the National Health Protection Mission can play a valuable role. The first-order priority should be to draw up a road map for universal health coverage, through continuous upgradation of the public sector infrastructure.

Vocabulary

Access: a means of approaching or entering a place.

Example: The staircase gives access to the top floor

Synonyms: entrance, entry, way in, means of entry, approach

Essential: absolutely necessary; extremely important.

Example: It is essential to keep up-to-date records

Synonyms: crucial, necessary, key, vital, indispensable, important

Appears: Become visible or noticeable, typically without visible agent or apparent cause

Example: Smoke appeared on the horizon

Synonyms: become visible, come into view, come into sight, materialize, pop up

Adequate: satisfactory or acceptable in quality or quantity.

Example: This office is perfectly adequate for my needs

Synonyms: sufficient, enough, requisite; acceptable, passable, reasonable

Implication: the conclusion that can be drawn from something, although it is not explicitly stated.

Example: The implication is that no one person at the bank is responsible

Synonyms: suggestion, insinuation, innuendo, hint, intimation, imputation

Prescribe: advise and authorize the use of (a medicine or treatment) for someone, especially in writing.

Example: Dr. Greene prescribed magnesium sulfate

Synonyms: write a prescription for, authorize

Persuade: cause someone to do something through reasoning or argument.

Example: It wasn't easy, but I persuaded him to do the right thing

Synonyms: prevail on, coax, convince, get, induce, win over, bring around, coerce

Apprehension: anxiety or fear that something bad or unpleasant will happen.

Example: He felt sick with apprehension

Synonyms: anxiety, worry, unease, nervousness, nerves, misgivings

Imperative: giving an authoritative command

Example: The bell pealed again, a final imperative call

Synonyms: peremptory, commanding, imperious, authoritative, masterful