Is Ayushman Bharat really a game changer of a health scheme for the poor? Will it help increase the longevity of the poor citizens of Bharat that is India? There have been doubts galore even as the scheme is launched with much fanfare.
Now called ‘Pradhan Mantri Jan Arogya Yojana’, the scheme aims to benefit more than 100 million economically backward families, or about 500 million poor people, representing 41 per cent of the country’s population. Each family will be entitled to a cashless health cover of Rs. 5 lakh every year, which they can avail of at empanelled government and private hospitals for ailments as varied as neurosurgery, neonatal care and stenting, totalling 1354 treatment packages.
As in any scheme in India, intentions are noble but the problem comes in the implementation stage. Is the rural India ready for the scheme? Does it have enough infrastructure in terms of hospitals and beds? In remote villages the nearest health facilities are so far away that one may need to travel hundreds of kilometers to get there.
Urban India has many private hospitals; the real challenge is in increasing the number of hospitals in Tier 2 and Tier 3 cities, and in villages.
Will the private sector be interested in setting up hospitals in villages, especially remote ones, when these would probably not be commercially viable despite the government footing the bills?
To make the scheme work, hospitals, existing and new ones, have to be strategically located so that patients do not suffer for requirement of adequate beds. This means distribution of hospitals and beds should be more or less equitable.
Then there is the problem of funding the scheme that aims to provide free insurance cover of Rs 5 lakh to about 100 million poor families. This will cost the Centre at least Rs 10,000 crore annually. The Centre says the Rs 10,000 crore allocation would be funded by a ‘health and education’ cess (hypothecated tax) of four per cent on personal income and corporation tax. Won’t the middle class and the corporates crib? Four per cent additional tax is surely a burden on the middle class, at least.
Then there is the funding ratio that many non-BJP ruled States may find as a bad turn on them. Under the scheme, most of the States have will will to bear 40 per cent of the total cost, while some, such as Himachal Pradesh, Jammu and Kashmir, and Uttarakhand, will have to shell out only 10 per cent. Some State have already protested and have refused to implement Modicare as they already have their own healthcare initiatives in place, which they claim are much better and more inclusive.
One such State in Odisha. Its chief minister, Naveen Patnaik has said that his government scheme, Biju Swasthya Kalyan Yojna, covers 5 million more people compared to the Centre’s scheme and promises Rs 7 lakh per family.
Other States which have turned down Modicare are Telangana, Delhi, Kerala, Punjab and Andhra Pradesh. Delhi Chief Minister Arvind Kejriwal has dubbed PM Modi’s scheme as nothing but a ‘PR exercise’ that, he says, would turn out be be another ‘jumla’.
Kerala has questioned the feasibility of Ayushman Bharat, saying the scheme, touted as the ‘world’s biggest health insurance programme’ is a big hoax as the financial model of this kind can only be operated on the assumption that one doesn’t have to pay.
Kerala Finance Minister Thomas Isaac says the State’s share of 40 per cent of the total cost would would be a huge financial burden on the State exchequer. “If we are not allowed to customise it, it will break the State’s health care system. It’s so ridiculous.” Andhra Pradesh and Telangana have their own health insurance scheme, ‘Aarogyasri’, that is running for more than 10 years. Telangana says it will stick to its health programme’, which covers nearly 85 per cent of the population as against only 8.5 million families covered under Ayushman Bharat.
So says Andhra Pradesh.
The main objection against the Ayushman Bharat scheme is that its eligibility criteria leaves out a number of beneficiaries that are currently being served under different States’ health schemes. But the real problem will come when the hospitals start implementing Modicare. What if the expenditure of a family shoots beyond Rs 5 lakh and the insurance companies refuse to honour their commitments?
And what happens to post hospitalisation expenses when patients have exhausted their annual family quota of Rs 5 lakh? A coronary bypass surgery patient or say a cancer patient needs regular expensive medicines after the operation. So does many other patients. Who will foot those bills for these poor? These are among some serious issues that are going to crop up in making Modicare successful.>