Ayushman Bharat is a very purposeful mission and a powerful slogan

There is a need for an eagle eye approach to employment identification and creation rather than a lackadaisical one, witnessed by us for over 70 years.

There is a need for an eagle eye approach to employment identification and creation rather than a lackadaisical one, witnessed by us for over 70 years.
There is a need for an eagle eye approach to employment identification and creation rather than a lackadaisical one, witnessed by us for over 70 years.

On a minute consideration of the daily life of Indian society, there cannot be a failure to create livelihood if that is the mission.

Employment is natural in a vibrant society and is as much a challenge as it is a cause of social happiness. Unemployment is a perpetual issue in Indian society where the employable in the organized industry will be more than the ever-shrinking opportunities due to evolving technologies.

Yet there is a need for an eagle eye approach to employment identification and creation rather than a lackadaisical one, witnessed by us for over 70 years. We have never had the much needed Minister for Employment. On a minute consideration of the daily life of Indian society, there cannot be a failure to create livelihood if that is the mission. Opportunities are immense.

Life is the cause of an economy and quite humorously the economists try to construct an economy as the nucleus of life and society. This is the fallacy of materialistic literacy. Jobs make up not just families and society but also economies.

I now attempt to search out opportunities for employment in ways not conventional but furthering any national and social cause in the process.

Ayushman Bharat

A) Context:

After 70 years of independence still:-

  1. Every district in India doesn’t have a good government hospital.
  2. Therefore migration of Medical fraternity to metros and the patients also flock for treatment.
  3. Medicine is an expensive education
  4. Doctors have to earn more to recover their education costs.
  5. Corporate hospitals run on a pure profit motive.
  6. No standard operating procedure in the profession across the country.
  7. No counterbalance in society as government hospitals are corrupt and inefficient.
  8. No compulsion for doctors to do rural service. Large hospitals are in the metros and everyone wants to live in the metros.
  9. The medical services in urban areas are exploitive. Eg.:- Collusion with insurance companies/agents pharma companies.

B) Need:

Affordable medical facilities across the country which will treat common ailments and charge reasonably.

C) Concept:

  1. Under Ayushman Bharat, if the government takes up a mission of building a 50-bed hospital in each district across the country in partnership with private medical fraternity, over the next 3 years it will do a lot good. The number of beds can be increased to 150 in due course based on the response in each district in phase 2.
  2. To start with the hospitals must offer treatment for basic ailments, delivery, simple surgery, emergency, ICU, etc. A list of treatments that can be given in the hospitals may be laid out by the government. Any ailment beyond the list approved must be referred to the major hospitals. The list can be revised as the scheme takes off well with more experienced doctors coming in.
  3. The building will be constructed and all the basic equipment will be purchased and installed by the government. The hospital will be in a ready-to-start condition.
  4. This can be done in a public-private partnership:
  • The government will build and own the hospital under Ayushman Bharat.
  • The government can also attract donors for each hospital. If the hospitals are going to be run by private parties then it could attract larger public support (like TTD attracts donors for cottages).
  • The hospitals will be named Ayushman Bharat.
  • The private doctors will take up, run the hospital, and maintain it.
  • The hospital will be given to them for a period of 5 years on a management contract.
  • The government will post one administrator in each hospital. All hospitals will be connected in real-time with the Director-General of the program.
  • The operating norms will be set by the government.
  • Based on an objective performance appraisal the management contracts can be renewed.

5. The selection of the doctor management team who will be handed over the hospital will be on an objective and transparent basis. Preference to local doctors in each district can be given for ensuring continuity and stability.

D) Working:

  1. The management team must invest the working capital viz., salaries, and operating expenses.
    Since the management team has to manage the working capital, they will do it very cost-effectively. They will put up a security deposit also.
  • The government will fix a price list for all the treatments reasonably to provide for a profit to the operating team.
  • The hospitals will not charge more than the fixed price list, by law.
  • Each hospital can be built on a one or half-acre plot. Also, the land in possession of Government/Public Sector Undertakings can be used.
  • To start with each hospital will be on a 10000 to 15000 sq ft.
  • The investment in each of the hospitals will not be more than Rs.20-30 Crores.
  • The Working Capital required will not be more than Rs.50 lakhs. A team of 5 doctors can put Rs.10 lakhs each and get to run a hospital.

2. The government will take 3% of the revenue. There is enough incentive for the managing team as the profit-sharing will keep them hooked to the job. Besides the above, each hospital can have an attached pathology lab, diagnostic service, a medical shop and ambulance service and some other related services to allow the management team to earn.

E) Supervision:

All hospitals will be online. It will be connected to a Director-General of the program. There will be a state-level Director also. The Director-General can see all the hospitals online with a video camera. He can do an inspection at any time. All billing is online. The administrator of the hospital will be posted on transferrable deputation by the government.

The supervision can be totally system driven.

F) Merits:

  • The patients can be covered by Ayushman Bharat even in states that don’t implement the scheme. This is a back door entry into such states.
  • Since Ayushman Bharat Scheme covers it, the patrons will be many. The hospitals will do well. It will also keep the Ayushman Bharat payouts in a check as the hospital rates are fixed, and exploitation is not possible.
  • The doctors will be at peace as there will be no collection pressure as it is in the private hospitals. The doctors from the local area will show a lot of interest. There will be stability.
  • Good students who come out of medical colleges successfully but don’t have the capital to set up a hospital on their own will be enthusiastic participants. The hospitals can grow over a period of time with good service. Good talent can be attracted due to the revenue sharing formula.
  • The government will always own the hospital and it will be the ultimate authority to keep or terminate the contract of the management team (similar to how large hotel chains running, operate). No exploitation will happen as in a private hospital as the management team will be worried that their contract may be terminated.
  • The government can start this in few districts as a trial and if it is successful can expand it to all districts in India. It will automatically gather a lot of interest as doctors will get attracted to the scheme. It will give them a sense of participation and ownership in the National service.
  • Most importantly this will help the government keep a check on hospital charges across the Country. It will be a benchmark.
  • Ayushman Bharat hospitals can develop into an affordable national health care system.
  • Promote a University for Medicine and Public Health, Management system to train and produce future bureaucrats for public health management.
  • Bring about some uniformity in standards of treatment across the country.
  • Can pass Ayushman Bharat benefits to the public without pilferage, fraud through DTB.
  • Employ qualified people in their own districts and arrest migration of the educated to metros.
  • Services become localized. The cost of services will be lower if localized.
  • Each hospital to grow to not more than 150 beds. Beyond that, open a new one in the same district. Disburse the crowd. Disburse employment. Disburse incomes.
  • The system is subject to 24×7 scrutiny
  • No operating responsibility on a full-time basis for the Central Government. No pilferage, fraud, and such current problems.
  • No operating expenditure on the government.
  • Capex initially can be funded by the government and also donations from affluent individuals who want to do a social service by donating a hospital.
  • Encourage local entrepreneurship at the district level.
  • Success is guaranteed as Ayushman Bharat scheme supports the hospital.

G) Employment Potential:

  • 3 hospitals in each district on an average in 5 years. Large Districts can have more.
  • Each hospital will support directly and indirectly at least 150 people including various services.
  • Quality employment of nearly 5 lakh people in 3-4 years.
  • The spillover effect on insurance, other allied services, hospitality near hospitals can be more.
  • Addresses 3 problems
  1. Health services across India will leap in quality, availability,
    affordability.
  2. Government control on an important aspect of public life.
  3. Generates employment.

This could be an easier way to combine the might of the government and the skill and services of the private citizens for the common good of all. It would be a win-win situation for the government and the medical fraternity on hand and the public will get new hospitals in each district. Ayushman Bharat will become very popular and successful and an employment creator. A chain of 2500 hospitals across the country (3 in each district) over a period of 5-10 years will make this the largest government effort in public health anywhere in the world.

Note:
1. The views expressed here are those of the author and do not necessarily represent or reflect the views of PGurus.

54 COMMENTS

  1. The Article Ayushman Bharat By Arunaachalam Nandakumar is very well researched and gives a very comprehensive view of the scheme of things. the approach taken in the article is methodical breaking it into bits and making it lucid and insightful. please keep sharing more articles

  2. This is indeed a model which is very viable and could benefit the country. Sans of course the bureaucracy and corruption. However, if such a model is indeed implemented, then, it would only benefit this nation. Very nice thoughts and a good/refreshing read uncle.

  3. I strongly feel this article should reach Honorable Prime Minister Mr Narendra Modi, such a detailed Road map and clarity in the article, I think Prime minister may implement this. Mr nandakumar articles are very informative and purposeful articles.

  4. Very insightful and thoughtful article by Mr.Nandaa Kumar. The ideas in the article can address healthcare issues and make it affordable across the country. Also, it has the potential to generate employment

  5. Author has given a very clear road map for improvement of health services starting it from Distt level . Guidelines can be issued for deploying CSR funds for creation or upgradation of facilities at Distt level as suggested with public pvt partnership . This will help our health services immensely as undue crowding in bigger hospitals will also reduce there by helping the health services not only in smaller towns but larger cities .
    I think it’s an excellent idea which should be taken up both at centre and state level for support . It makes the investment sustainable as Govt has not to shell out money every year for services .
    It will attract huge public support and even crowd funding in the Distt will also help make the facility top class in each Distt .
    Must go for it .

  6. Good read and very informative article..Demand surpasses Supply in the sector and Affordable healthcare is way forward.. Huge opportunity to scale up and create employement and given current environment – Healthcare would be in forefront and major priority of all stakeholder..

  7. Very accurate analysis of the current gaps in health care. The suggestions are pragmatic and will benefit the county immensely. A very good read. Looking forward to more such articled.

  8. Very worthful article written by Nandaakumar. All most 60 % of population in india are in rural areas. There is no medical facilities in rural. If government impliment the suggestions given in article, every middle class families can get medical service with affordable cost.

  9. No doubt that Ayushman Bharat is much needed and the author has nicely jotted down the way forward. Apart from these steps, the fundamental requirement is Medical Education to be made free of cost and should be accessible to people at all strata of life as against the present trend of only the rich can afford. Definitely NEET has contributed to a greater extent. Rural hospitals at every village is a must. Health care business should be only in the hands of the government to avoid the possible exploitation which is the order of the current scenario. The nexus between insurance companies , pharma companies, health care professionals and the private hospitals should be nipped in the bud. Unless the cost is controlled at the beginning itself, the health care may become the dream of many.

  10. Very good idea. Hope the government considers & take appropriate steps & make India the best place to live in.👍

  11. The author Mr NK has researched very well and have suggested the right way to take our health care forward.
    His ideas will bring out the entrepreneurial aspirations from Doctors who would have not been able to reach due to infrastructure investments and will strive hard to make this model a great success , every district needs Hospitals like this one and even small towns with 50 K plus population also needs a hospital like this one and one can see the immense opportunity to reach poor peoples health care at affordable and controlled cost.
    Sincerely wish the government to take up the ideas shared by Mr. NK

  12. Sir:  This is an excellent idea and worthy contribution by your goodself for Developing India.  The need of the hour is to have such an Out of Box thinking and penning which you have been doing.  Your ideologies should not vanish unnoticed Sir.  With your clout at the Political and Bureaucratic levels at States and Central level, I am sure it would not be a difficult task for you to reach this out to the respective Governments.  I reiterate that I am one amongst your close disciples and always wish for your wellbeing.  Kudos Sir.

  13. A great write up especially during the critical economic scenario in the world right now. Health care assistance is very much required during the crisis and it is never too late to start working for the future. Hope we see more schools and health care services rather than other things.
    Wonderfully written and good suggestions.

  14. Ayushman Bharat is very purposeful mission as illustrated by author. The real social benefits will be to people living in interior towns of Districts. The power and responsibility needs to be given to local authority as its effectiveness/ efficacy is going to benefit them directly. Also burocratic decision making will not hinder their effective performance / efficiency. Central roll need to be limited to financial support and good guidance by way of latest technology / best practices and training / exposure to medical staff. Above all greenary, cleanliness, sanitation and good environment needs to be give top priority as in India it is still neglected area and has least priority. Also basic best practices of yoga needs to be introduce as daily routine through these centers to keep people healthy. The facilities needs to be made in such a way that people will not go unnecessarily to District or City. If the health of each and every town and District is taken care off , automatically the health of country will be improved. As it is rightfully said “Health is Wealth “

  15. Something like this makes healthcare more accessible and affordable. Key developmental aspect. Love the idea!

  16. Valid pointers raised and we need more thinkers who can give a wake-up call to the government before this opportunity is missed. This is definitely an eye-opener for youngsters too who need to come up with new ideas and execute with the government. I hope this article reaches to the right authorities or advisors of PM.

  17. It is a great and insightful suggestion. There is great clarity and vision. thank you and expecting more articles from you.

  18. Wonderfully articulated ideas on the health sector. Need of the hour. Appreciate the effort uncle.

  19. India will witness a revolution in the public health sector if the idea of the author is implemented.Along with easy and better accessibllity to well equipped hospitals it will aid to achieving other benefits as mentioned in the article .very good inputs.

  20. It is high time that a systematic and thorough approach with a wide reach has been developed to solve our economic and unemployment crisis in the Indian health care industry that has been running for a long 70 years!
    This scheme proposed by Arunachalam Nandaa Kumar addresses a lot of the key issues with well thought out solutions that has long term benefits that could span across generations if implemented well.The approach drawn out has multi-fold benefits for both the rural and urban population in terms of employment, health care and creating a sustainable economic eco-system within the rural areas.
    Preference to local doctors is a great proposition to ensure employment and foster greater economic stability in the area. Great opportunity to young budding doctors to apply and grow their talent and skills. Definitely a win-win situation with Health care standardisation, affordability, accessibility and employment.
    Hopefully this reaches the right ears and will put India on the global map as a role model in Health Care for the country.

  21. A very insightful article on the challenges faced by our society where access to quality medical facilities at affordable price is close to impossible. This article proposes a powerful model in applying government schemes to drive health care accessibility to common man, and also generate more employment in non-metros thus preventing brain drain within India

  22. Very beautifully written, this not only points the purpose of the scheme,but is an advisory to the government on the opportunities available on hand in health care, insurance, medical aid, distribution of medicines, employment both direct n indirect, overall economy boom.

    Not just at the state, but also at the.district level. Hope this eyeopener reaches the concerned.

  23. Good in depth study and visualisation. I appreciate NK for the thought process and clarity on his presentation. It should reach to the right authorities to start working on it.

  24. The author has done a great study on health service it benefit will be extended to nook and corner of India . Health is priority than food and shelter , hence government should focus on establishing more and more hospital to serve poor and medium people at minimum cost. This can only happen if the government provides infrastructure at competitive prices and hand over the establishment to private hospital run on revenue sharing. By doing this more employment opportunities will generate direct and indirect . It should be established in each and every district headquarters with 50-100 bed facility and infrastructure for all medical test. The employment opportunities should be given to district people so that movement or change of job does not arise. This scheme can be done through Ayushman Bharat scheme and insurance covered by government under scheme can be linked this program
    Implementation should happen in fast track with minimum cost, and hassle free permission in all respects to establish the project.
    The author Mr.Nandaakumar has done a wonderful work on this and all his suggestion is all acceptable. It is the government to take proper steps to implement by inviting the author to support and quise the team to implement. NGO’s also give taught on this Ayushman Bharat scheme to implement. I wish all the success in this more particularly author who has spent lot of time to draw the frame work and scheme

  25. PMJAY scheme aims to provide healthcare to 10 crore families Rural areas, who are mostly poor/ middle class family and have lower middle income, through a health insurance scheme providing a cover of Rs. 5 lakh per family. The 10 crore families comprise 8 crore families in rural areas and 2.33 crore families in urban cuties. Broken into smaller units, this means the scheme will aim to cater to 50 crore individual beneficiaries across the Nation

    However, the scheme has certain pre-conditions by which it picks who can avail of the health cover benefit. India’have Major concern Health matter, While in the rural areas the list is mostly categorized on lack of housings, meagre income and other deprivations, the urban areas list of PMJAY beneficiaries is drawn up on the basis of work

  26. Nice article on health care development and suggestion, also easy to understand the process. Great initiative by Mr. Nanda Kumar

  27. Good suggestion Nandakumar. I think the economic model for the private operator needs to make sense. A large hospital group can set up a mgmt company to run these hospitals by region and fund shortfall via CSR funds.

  28. Providing quality healthcare to every citizen is need of the hour. Excellent recommendations. Hope the article reaches the concerned authorities who can implement.

  29. This is an excellent suggestion. The administrative arrangements need some looking into for better management control but for starters the ideas articulated by Mr Nandaa Kumar are commendable. Perhaps age old native practices such as Ayurveda and homeopathy can also be offered as alternative practices at these centres.

  30. I feel this is a very important issue India has to address. It will help the country to overcome multiple problems like unemployment, health care for every citizen at an affordable price. It also generates jobs in the healthcare sector and allied sectors across the country. This will reduce the quantum of migration of communities to metros. The spread of hospitals Pan-India will reduce migration of people to cities. Ayushman Bharat will allow rural mass of India to avail unaffordable healthcare facilities at a reasonable cost to save time and lives.

    This scheme will fill the unemployment vaccum created the manufacturing sector during pandemics & emergency and maintain equilibalarium, make India health care hub and pave way for medical researching of vaccines, make India a hub for mfg.medical equipment & other products.

  31. Well written Article. Subject discussed is most relevant today. Deserves a serious consideration by the concerned authorities. Atleast, State Governments can think on these lines and consider appointment of one Medical Minister.

  32. Mr Nandakumar brings out clear cut guide lines to establish a methodical ,professional and disciplined system to make our motherland Ayushman Bharat.

  33. Mr Nandakumar brings out clear cut guide lines to establish a methodical ,professional and disciplined system to make our beloved mother India into Ayushman Bharat.Hope our Government will take in to consideration such valuable suggestions as guidance notes.

  34. A very well thought out and structured proposal by the author. Ambitious govt undertakings that can transform vital services at the grassroots level are key to transforming India .
    This template can be expanded to other vital sectors like education and sanitation also.

    Great piece overall

  35. This writeup by Mr Nandakumar brings out clear cut guide lines to establish a methodical ,professional and disciplined system to make our beloved mother India into Ayushman Bharat.Hope our Government will take in to consideration such valuable suggestions as guidance notes.

  36. One more fabulous article by Mr. Nandhakumar uncle… With an advanced technologies and greater manpower, even impossibles can be made possible. That too via concept like Ayushman Bharat, a greater knowledge can be made to reach the citizens of our country. Jaihind🇮🇳

  37. Health care has emerged as GOD and SAVIOUR of Mankind in this covid 19 times – almost every country in the world including the most developed ones have faced the challenge of inadequate health care system. In our country given the huge population and the availability of high number of competent health care professionals – such a model will do wonders and will probably make India the healthiest country in the world. Surely an approach to explore.

  38. Very precise and thoughtful the government should actually consider in implementing the ideas which would help in boosting the economy avoid rationalism and help in employment and building of good hospitals and thereby leading to healthy well being of the society,thank u sir for giving me an opportunity to go through the article.

  39. Great blueprint by Mr NK. This is an perfect solution to the growing nexus/menace and problem of providing quality healthcare at affordable rates. Your notes are detailed and can be implemented. They need to reach the right authorities!

  40. very good article on Health sector improvement and saving Rural population from clutches of Private Hospitals, Hope people incharge act on the suggestions given by Author to impove Health sector and also promote Indian Arurvedic medicine.

  41. Thought provoking article. I think this is a feasible solution for affordable healthcare for a country like ours. Keep it up Nanda kumar

  42. Very well articulated. The facts are figured out and excellent remidyial recommendation provided by the author. Kudos to Nandakumar.

  43. Very insightful. Health can provide employment and employment can provide health. Its very symbiotic. Congratulate Mr Nanda Kumar in expressing his views with such clarity. I can see his anguish to do something good for his country. I hope someone who matters is listening.

  44. Great Suggestion and we can plan Ayushman Bharat /Swabhiman bharat

    Indian Health Authority is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme ‘Ayushman Bharat / Swabhiman bharat …

  45. Very good thoughts and super simple brilliant suggestions to the government to implement and build hospitals in all district’s.
    As everyone is aware PM Modi has taken lot of measurements towards the Ayushman Bharat vision and have implemented in 3 states on trial basis.
    If it is successful things may start happening as per your suggestions.
    It is our duty to see that our visionary PM reads this article and take your suggestions also for future successful implementation.
    Keep it up Mr.Nandaakumar for your interest shown for the beneficiary of our great country.
    Expecting you to write more and articles which is important to our country at this hour.
    Well done and God bless you

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