Ayushman Bharat: While PM Modi’s intentions are noble, is India ready to manage such a huge project?

On Sunday, Prime Minister Narendra Modi formally launched Ayushman Bharat, which is part of  Pradhan Mantri Jan Arogya Yojana (PM-JAY) . The scheme, popularly called Modicare, was first announced by union Finance Minister Arun Jaitley while he presented the union budget for the 2018-19 financial year.

According to the scheme, PM-JAY ‘will provide financial protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). It will offer a benefit cover of Rs. 500,000 per family per year (on a family floater basis).’

On paper the scheme looks enticing, and provides hope to millions of Indians who fall below the poverty line, and can’t afford basic healthcare, and if implemented properly could cement Prime Minister Narendra Modi’s legacy. 

But when we deep dive into the scheme, there are several challenges that the government faces to make Ayushman Bharat a success. 

INDIA’S HEALTHCARE SHORTAGE

Firstly, India has a shortage of doctors across public and private hospitals.  Sub-district hospitals or Community Health Centres (CHCs) at the taluka level suffer the maximum brunt of lack of infrastructure and shortage of human resources, Union Ministry of Health and Family Welfare data shows.

While 22,496 specialists are required across India to run CHCs, only 11, 910 or 47% posts have been sanctioned. What is more shocking is that of the sanctioned 11, 910 posts, only 4,156 posts are filled while close to 65% posts are lying vacant. Providing safe healthcare at grassroots is impossible without specialist doctors who ensure timely surgeries of patients and ensure safe maternal and child health services. 

It was also revealed that in India, there is one government allopathic doctor for every 10,189 people, one government hospital bed for every 2,046 people and one state-run hospital for every 90,343 people. Data from the National Health Profile 2017 also shows 10% work of India's doctors work the public health sector.

And while Ayushman Bharat has said that a number of private hospitals will fall under its ambit, it will still pose the doctor to patient challenge if patients decide to come to private hospitals.

HOSPITALS MISUSING HEALTH INSURANCE

If a hospital – particularly a private hospital – knows you’re covered, then expect every test to be done, even if it’s not necessary. There will be things such as an ‘ergonomic pillow’, ‘mattress for back support’ and other unnecessary factors added to the service that the healthcare business provides to patients today. As a result, the Rs 5,00,000 insurance that Ayushman Bharat provides to each family could be used up by one patient, if the hospital decides to call the shots. In the case of a BPL family, they won’t know the difference between what is necessary and what is not, as long as their family member is well looked after.

INDIA’S MIGRATORY POPULATION

Firstly, there is a migratory population that the government has to deal with. This migratory population comprises the people living below poverty line (BPL) in urban slums. Due to several factors including municipalities reclaiming the land on which they have built their homes, they usually disappear from the national census of a particular area because of forceful eviction. This population may have difficulty in obtaining an Aadhaar card due to the constant change in address.  

WHERE DOES THE MONEY COME FROM?

During the 2018-19 budget, union finance minister Arun Jaitley announced an estimated Rs 54,667 crore for healthcare - a 2.7% increase from the previous year.  

The budgetary allocation for PMJAY is Rs 2,000 crore in 2018-19, and the scheme claims to benefit 10 crore families (50 crore people). With only Rs 2,000 crore being allotted, it remains a mystery where the money will come from , as the government is yet to disclose this detail.

Kerala finance minister TM Thomas Isaac was also critical of the scheme. Taking to Twitter, he said, "Total claims under RSBY so far are 12 million. Kerala accounts for Rs 5.3 million. A state with a population share of three per cent, accounts for 42 per cent of the claims -- a sad commentary on implementation. Ayushman Bharat also is on the same track." 

Besides Kerala, Telangana, Punjab, Odisha, and Delhi have announced that they will not avail the scheme. 

ROAD AHEAD

The progamme can be the greatest thing that has happened to India with regards to affordable healthcare for all. However, the need for proper step-by-step implementation is necessary otherwise Modicare has the chance of becoming just another health cover for India.

The author is Assistant Features Editor at DNA. Views are personal