India is currently in a state of health transition. Infectious diseases such as tuberculosis, malaria, dengue, H1N1 and antimicrobial resistance remain a persistent threat to health and economic security. At the same time, the country is having to confront the emerging problem of chronic non-communicable diseases such as cardiovascular diseases, diabetes, cancer which has now become the leading cause of mortality in India.
This epidemiological transition is being fueled by social and economic determinants of health, as well as by demographic changes such as an ageing population, by environmental factors such as climate change and pollution, and by factors such as globalization, urbanization and changing lifestyles.
Adding to this ordeal, the survey of 2015 by NSSO presented some alarming statistics on the extent to which medical emergencies impairs the finances of poor families. The survey showed that hospitalisation expenses for critical ailments had shot up by 300 per cent over a decade. With over 80 per cent of the households not covered by any health scheme, most of the cost was met out-of-pocket. An estimated 6 million families sink into poverty each year due to hospitalisation.
To provide a certain amount of relief from this epidemic situation, the Government of India, in collaboration with the States and the Union Territories launched a free health insurance scheme for the poor and the vulnerable families, under the name of Ayushman Bharat or Pradhan Mantri Jan Arogya Yojna (PM-JAY), also dubbed as the world’s biggest insurance scheme.
What is Ayushman Bharat?
Ayushman Bharat is a health insurance scheme under which 10.74 crore or 107.4 million households or at least 50 crore or 500 million individual, or about 40% of the population of India will be eligible for reimbursement of up to Rs. 5 Lakh per year towards hospitalisation expenses in secondary and tertiary services. Apart from the expenses on in-patient treatment, the scheme also covers pre and post hospitalisation expenses up to a certain extent.
Socio-Economic Caste Census (SECC), 2011 provided a list of families in poor and vulnerable conditions, which forms the base for this scheme. This list bifurcated the families into two broad headings: rural and urban. In rural areas, households living in one room kuccha homes, those with no adult members, those headed by women, those belonging to SC/ST, the homeless and landless are some of the beneficiaries. In the cities, beneficiaries include rag pickers, street vendors, domestic help, sanitation workers, shop workers and so on. There are about 8.03 crore or 80.3 million families from rural areas and about 2.33 crore or 23.3 million families from urban areas.
Under the scheme, patients are entitled to get cashless treatment from empanelled government and private hospitals. Insurance payouts will be based on the package rates prescribed by the government for 1,354 ailments. But for anyone to avail of the scheme, his or her name must feature in the SECC database and he/she must furnish proof of identity (not necessarily Aadhaar) to enroll.
Ayushman Bharat subsumes the Rashtra Swasthya Bima Yojana (RSBY), which promised Pradhanannual insurance of Rs 30,000 per family and targeted initially the Below Poverty Line (BPL) families, which was later expanded.
Finances of the Scheme
The premium cost of the scheme is to be shared by the Centre and the States in the ration of 60:40. The estimates suggest that this scheme will cost around Rs. 12,000 crore to the Government annually, but in this financial year it be only around Rs. 6,000 crore as half of the year has passed. The States have are expected to voluntarily opt into this scheme. The collaborative model ensures that the State Governments provides support till the last bit of the healthcare services. As of now, 26 States have opted to join in the scheme and 8,700 public and private hospitals have empanelled. The States (New Delhi, Kerala, Odisha, Punjab and Telangana) who have yet not opted into this scheme is majorly because these states already some kind of an healthcare schemes going on in the respective states and thus are looking for the added benefits of Ayushman Bharat before opting in.
One of the major concerns is that the Government of India has provided for only a budgetary allocation of Rs. 2,000 crore, which according to the estimates seems to quite insufficient. How will the Government go on about on this issue remains to be seen.
The Future of Ayushman Bharat
On paper the scheme is a very good prescription for the needy, but in implementation there seems to be some hiccups which may be creased out in the future. The first and foremost is the budgetary allocation for the scheme. There is an estimated need of Rs. 6,000 crore as against the Rs. 2,000 crore allocated in the budget for this year.
The second is that the Government has to regulate the prices of the services of both the public and the private hospitals, otherwise the scheme will not be able to provide the benefits that it intends to. The condition of the public hospitals is not at all good, most of the hospitals do not have the doctors to attend to the patients and other do not have the facilities to take the proper care of the patients. Under such circumstances, the people are forced to go a private hospital, which provides their services at an exorbitant price which the scheme may not be able to cover, as the scheme will cover only the prescribed rates. Thus, the Government either have to regulate the prices of the services under the scheme or otherwise provide for the shortcomings of the public hospitals.
The third is the inclusion of primary services to the scheme. The scheme today, covers just the secondary and the tertiary services, which does not provide an all-round coverage to the people. This major rider can also become a deterrent to most of the people for availing benefits under this scheme. The fourth is a minor one and has been provided for in the scheme. The eligibility is based on the Consensus of 2011, and nearly a decade later, many people will not have a mention on the list. To counter this issue, the Government has provided with Ayushman Mitra or Arogya Mitra, who can be contacted with the necessary documents, to get enlisted under this scheme.
Thus the agenda behind this scheme is very good and it is one of the best social welfare schemes in the recent past and will also overshadow the other social welfare schemes of this and the previous Government. Though the agenda is great, the implementation is the key. So to make this scheme successful implementation has to be looked after, which generally has been the weak point of the Indian Governments.
If all the blockages in this initial stage of the scheme are removed than this will be a major boost to the healthcare of the people of India in general and the poor and vulnerable in particular, and will also provide a boost to the Indian Economy.