Author: Anondeeta Chakraborty, BA (Political Science) 2020. St.Xavier's College (Autonomous), Kolkata, MA (Political Science). Pursuing St.Xavier's College (Autonomous), Kolkata
India- A democracy boastful of its socialistic ideals and a welfare model of governance; something that has been so fashionably enshrined in the constitution in heavy, ornate jargons, took 71 years to legislate a comprehensive health scheme for its citizens. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) was initiated in 2018, with the aim to provide an annual health insurance of Rs. 5 lakh to families below the poverty line (BPL), (regardless of their size). By the Union Government’s data, about 40% of the total population comes under this scheme and today itenfolds around 100 million families.
In a country with dismal public health infrastructure and exorbitantly expensive private healthcare system, the Ayushman Bharat Scheme is indeed a commendable and an adventurous step towards providing universal healthcare and bailing out the financially weaker section with a much needed assurance.
Before going into the whole debate about the efficacy of this scheme, some key aspects of the same must be kept at the forefront.
Despite being a union scheme, the onus of implementation lies with the states.
The programme is planned to be financed and executed through a PPP (Public-Private Partnership) Model.
Under the AB PM-JAY, the subsisting primary rural health care centres and sub centres have been converted to Health and Wellness Centres (HWC), with the aim to provide extensive primary health care, starting from diagnostic services to maternal and paediatric health services.
As mentioned at the outset, this scheme is only reserved for the population living under the BPL. The lower middle class and the financially frail people in the organised sector are kept out of this scheme.
While celebrating the one year anniversary of the project in 2019, the Ministry of Health and Welfare published laudable numbersand statistics, in an attempt toportray its success. But as many public health specialists have warned, an evaluation of the adequacy of the AB PM- JAY scheme based on mere numbers will be highly misleading. In reality it is replete with a plethora of drawbacks.
The very fundamental liability of this project, i.e., its implementation lies with the states. Practically enough, the potential of each state to allocate finance and infrastructure for carrying it out, remains starkly unequal. Keeping this in view, the PM JAY has provided the states and UT with the prospect of undertaking different implementation modelsviz trust mode, insurance mode and a mixed both as a combination of both. But it still remains notoriously complex and haphazard.
With around 1.15% of the GDP, being spend on health, the huge amount of money that is needed to provide insurance to such a humongous number of people, is naturally putting additional stress on the Government’s shoulders, but with the finance allocated for health remaining fixed. Undoubtedly, the infrastructure of our already ailing heaimplementation models le further. The PPP model has also remained pretty ineffective as AB-PMJAY fails to penetrate the top corporate hospitals. Malpractices among the private actors involved and lack of accountability on their part have plagued the model further. Impractical rates and retarded payments from the Government have also compelled some private actors to leave the scheme.
The rural HWCs which are being rejuvenated from primary care centres have been stressed beyond its capacity. The list of services provided has twice increased but the existing infrastructure has not been developed accordingly. The presence of these care centres in the rural areas still remains negligible.At the urban centres as well, the super speciality clinics and public hospitals are simply overburdened. The incredibly low rates kept for different procedures, will eventually downgrade the quality of service or will just make them unfeasible for hospitals. Aware of this, many states like West Bengal, Punjab, Kerala, Odisha, Telangana and Delhi (union territory) have preferred to be out of Ayushman Bharat.
The lower middle-class group has nowhere been taken into consideration. The definition of what constitutes the BPL class in India has been very vague and not well researched. Thus, when met with an unexpected huge medical expense, a lower middle-classfamily might just be pushed well below the BPL. Moreover, the deficient Artificial Intelligence based surveillance system in India, has given rise to forgery in procuring the e- cards of AB- PMJAY by ineligible people or claiming false relationship to these cardholders for availing free services.
The Covid’19 pandemic has further unravelled the inadequacies of the AB PM-JAY. The fatigued public health infrastructure, the never-ending waits to get covid tests and treatment done under the scheme, or the unequipped HWCs where communicable diseases were never included to be treated in the first place and the ruckus that thus followed in rural India, are some cases in point. As lofty and noble, the AB PM-JAY might sound in theory, its proper execution is impossible without significantly expanding the resources allocated for public health. To ensure that the scheme lives up to its full potential, yearly reviews coupled with the development of health infrastructure at the grassroot level, amendment of the procedural rates for private players to pitch in, and ensuring transparency by the inclusion of advanced technology and legal actions to prevent forgery and misuse, is therefore absolutely imperative. Only then the vision of “ek kadam achheswasthayakiaur” can be realised.
Summary
The article seeks to analyse the limitations of one of the most ambitious health schemes ever legislated in India- the Ayushman Bharat. The views are established by exploring opinions rendered by many public health specialists across the country, various statistics published by think tanks and the Government as well as the trend evident from the implementation of this scheme in the last 3years.