Expecting a rebound in health services: Ayushman Bharat CEO Indu Bhushan

The scheme was launched in September 2018 and every quarter we were going up in a big way, says CEO Bhushan

As Covid-19 cases decline in the country, the Ayushman Bharat or the PM-JAY scheme is looking at a comeback to the pre-pandemic level soon. In an exclusive interview, Ayushman Bharat CEO Indu Bhushan spoke to Nivedita Mookerji on the Covid stress, vaccine hesitancy, National Digital Health Mission and expectations from the Union Budget among other things. Edited excerpts:

Has Ayushman Bharat met the target set for it?

It has been a difficult period for almost last one year. The scheme was launched in September 2018 and every quarter we were going up in a big way. By the third or fourth quarter of 2019, we were doing about 800,000 to 1 million cases or treatments per month. That translates to more than 10 million every year. But with Covid starting in our short life cycle, we stagnated in the first quarter of 2020. In the second quarter after March, we went down drastically--about 60 per cent—and it remained low for a long time. It’s only in the last quarter of 2020 that we started growing again. Right now, we’ve reached about 80 per cent of our peak. For private hospitals, we’ve exceeded the pre-Covid level, but for public hospitals we are at about 70 to 80 per cent.

Why didn’t people turn up during Covid?

There were many reasons on the demand side. People didn’t want to leave home and least of all to hospitals. Also during the lockdown, there were restrictions on movement. So, all the elective surgeries like cataract reduced by 90 per cent and only the critical surgeries which couldn’t wait didn’t go down that much. All that could wait, waited. On the supply side, many of the hospitals converted to Covid only hospitals. Also, many private hospitals closed because of the fear of Covid and in some cases because of the lockdown. Many reduced their services including shutdown of OPDs. There was disruption in the entire economy and the impact was greater in the health sector. So, we have lost one year in our two-year journey so far …. Given that, we are happy having crossed the 15-million mark for treatment.

Are the hospitals, which were shut down, back?

Many of the hospitals are still not active, especially a lot of public hospitals. Earlier, private hospitals were the first to close, but they have mostly returned. Public hospitals are not fully back.

Haven’t many doctors lost employment?

Well, many sectors would have seen this impact because of the slowdown, both in terms of jobs and salary levels. But for health, it’s only a temporary dip I think. If you have a cataract, you can postpone the surgery for six months or one year but you will come back. We are expecting a rebound effect where all the pent-up demand would materialise soon. We hope to get back to the pre-Covid growth trajectory pretty soon, may be in the next three months.

How will Ayushman Bharat be involved in vaccine delivery?

We have not been per se involved in vaccine delivery but we have been supporting the Co-WIN application (the tech platform for vaccine delivery being managed by the Union Health Ministry). Since we are dealing with the National Digital Health Mission, we are integrating health IDs with the Co-WIN app. People who are coming for vaccination need to show proof of identity and one of them is health ID. We want to leverage the vaccination process to issue a large number of health IDs and in times to come link those health IDs with electronic medical records of those people, of course with their consent.

There has been some controversy around the National Digital Health Mission on data privacy. Has the issue been resolved?

That’s a genuine concern. Will the data be secure and private—that’s our concern too. We have made all efforts to ensure privacy  and security by design so that data is safe and is used by free and fair consent. All our systems are storing data in government community cloud with appropriate firewalls. We have been doing pilots in six union territories and the experience has been positive. We have created close to 1 million health IDs.

What’s the target for a national rollout?

That will be decided by the government. In a way we are going national by issuing health IDs through Co-WIN. We have given close to 100,000 health IDs through this platform.

Since you mentioned Co-WIN, what do you make of the vaccination mood?

On day one, we vaccinated close to 200,000. That’s more than anywhere else in the world. In the US, the number on the first day was 20,000… For any new thing, there’s always an initial resistance, but the numbers will go up in India. It’s a question of time when you will see enthusiasm on the street.  

On the Budget, what’s your expectation on Ayushman Bharat?

Budget has never been a problem for Ayushman Bharat and we hope the trend will continue.

On the whole, what’s your sense of the Budget?

I’m sure, there will be a greater focus on the health sector and we will be making some progress towards the policy of increasing the health budget to 2.5 per cent of the GDP.