Dr R Kumar
President, Society for Promotion of Ethical and Affordable Healthcare
SETTING up 1.5 lakh health and wellness centres (HWCs) across the country can be a game-changer to realise the goal of healthcare for the teeming millions of India. Health insurance and Mission Indradhanush have hogged the limelight, but the HWC component has got sidelined. The latter is a vital part of Prime Minister’s Jan Arogya Yojana (PM-JAY), also called Ayushman Bharat.
India cannot afford the luxury of ensuring patient care to all or even 40 per cent poor citizens under Ayushman Bharat. Health preservation for all is a more practical proposition. Emphasis on prevention is a prerequisite for the programme’s success.
Wellness means that a person is free of risk factors for disease and does not practise adverse behaviour, such as smoking, drinking and taking drugs, that could jeopardise health. The terms ‘wellness’ and ‘health’ are not synonymous. Wellness is the “active process of becoming aware of and making choices toward a healthy lifestyle, fitness and well-being.”
Essentially, if health is the goal, wellness is the way to achieve it. Wellness is the action, while health is the desired outcome. If wellness is practised, diseases can be kept at bay.
A conscious effort to improve wellness can ultimately reduce treatment costs. If 80 per cent of the people who throng hospitals as patients do not fall sick, it will be easier to give health insurance cover or provide treatment to the remaining 20 per cent in hospitals.
Viewed on a larger canvas, the setting up of HWCs will be of great benefit to the employers of corporate houses for enhancing productivity. Educating the workforce about wellness and lifestyle changes, such as drinking plenty of water instead of tea; walking to office instead of using a vehicle; taking a walk during breaks instead of sitting; spending less time on the mobile phone; and packing fruits and vegetables or home-made lunch instead of ordering junk food can help people achieve their wellness goals. The government can intervene to reduce the content of excessive salt, sugar and trans-fats in packaged food. Setting up gyms or making a provision for outdoor sports on corporate or institution premises can boost wellness and increase productivity. This will be of great importance for health insurance companies also. If they administer wellness to their policy-holders rather than wait for them to fall sick and then reimburse medical treatment costs, their own profitability will increase. This will also promote the penetration of universal health insurance.
Health insurance under Ayushman Bharat, which offers to meet the cost of hospitalisation up to Rs 5 lakh per family, has made a good beginning. Dr Indu Bhushan, CEO of Ayushman Bharat and the National Health Agency, vouches for its initial success with 7 lakh hospitalisation cases, Rs 900-crore disbursal and 45 lakh registrations under the programme in the first 100 days.
However, insurance is only a palliative for 40 per cent poor population, leaving aside the remaining 60 per cent. Do we have the resources and infrastructure to spend Rs 5 lakh per family for over 10 crore poor households? How to ensure that it will be implemented ethically? The HWCs, when set up, will provide primary medical care, free drugs and diagnostic services. These will handle more than 70 per cent of the outpatient load. These will also ensure medication compliance and follow-up care, saving people from the exploitative and unethical practices that are allegedly rampant during hospitalisation.
Estimates show that it will cost about Rs 20 lakh to set up and run an HWC. Thus, the annual spend on HWCs will be Rs 30,000 crore. The Union Health Ministry has neither allocated the resources nor has the national health budget been raised from about 1 per cent of the GDP to the promised 2.5 per cent. However, it will be unfair to condemn Ayushman Bharat as a utopian or election stunt. If a nationwide network of HWCs is set up and resources are provided, it can achieve the objective of a healthy India.
Studies in countries such as Brazil show that good health can be attained through preventive and primary healthcare. Closer home, a study from Tamil Nadu of 67 HWCs shows that out-of-pocket expenditure on medical treatment has reduced dramatically, while people’s access to medical treatment and its utilisation have improved considerably.
In the Indian context, where there is a perennial shortage of doctors, an institution of ‘wellness and well-being coach’ (WWC) needs to be created. You don’t need a doctor for remaining healthy. For the training of WWCs, you don’t require a medical college. It can be a four-year BSc course in wellness and well-being in colleges. The WWCs can take charge of wellness practices and preventive health of the entire population, and administer health education on their doorstep. In case of illness, the WWC can refer the patient for primary, secondary or tertiary care under Ayushman Bharat. The institution of WWCs has the potential to create millions of jobs and reduce expenditure on opening medical institutes as well as tertiary patient care.