In order to improve healthcare, the central government launched Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya Yojana (PMJAY) on 23rdSeptember 2018. It is also known as National Health Protection Scheme or ‘Modi Care’. It is the world’s largest health insurance scheme. It has a benefit cover of rupees 5 lakhs per family per year. This scheme will cover 10 crore poor families by providing them insurance cover upto 5 lakh rupees per family per year for their treatment.
After the launch of this scheme there were many reports, both positive and negative, related to its implementation. The Ayushman Bharat Yojana CEO, Dr. Indu Bhushan said that over 12 lakh people have received free treatment under the scheme, while around two crore beneficiary e-cards have been issued as on February 2019. At least 15,000 hospitals have so far been registered under the scheme, out of which 15% are private hospitals (Business Standards, 2019).
Previous data: Data shows that in 2011-12, about 55 million Indians were pushed into poverty because of healthcare expenditure which they could not afford(Times Of India, n.d.). At the national level, India has only 0.62 doctors for every 1,000 people, which is a matter of much concern (Economic Times, 2017).
Problems with this scheme:
The main concern with this scheme is that it is not easy to implement. Rampant fraud and corruption led to the closure of the Rashtriya Swasthya Bima Yojana (RSBY) scheme in Rajasthan. This scheme was a massive failure leading to increase in out-of-pocket expenditure by the beneficiaries while excluding the poorest, as assessments have shown. Then there is an example of Andhra Pradesh’s Rajiv Arogyasri scheme which draws 25% of the state’s health budget, but covers just 2% of the disease burden in the state (‘What the Economy Needs Now’, by Abhijit Banerjee). Even a report by the Standing Committee on Health and Family Welfare said that Ayushman Bharat was not a “step forward” from the existing insurance schemes.
Even for this scheme, there are reports that the patients are being forced to pay extra for those services which they are entitled to receive free of cost.
The scheme is mainly for the poorer and weaker sections of the society, who hardly know about its benefits and they don’t even care to research about them. Hence, they are exploited, mainly by the private players.
Due to the shortage of doctors, as mentioned earlier, it is very difficult to implement this scheme on the ground.
Private hospitals have started writing to the government informing them that their proposed reimbursement package rates are insufficient. Many have indicated that they may be unwilling to participate in the scheme at all.
If the private players are using this scheme for their own benefits and giving wrong treatments to patients, then the government will have to decide and settle disputes about which treatment patients should receive, depending on their disease and how much it would cost. The government does not yet have the capacity to make these decisions, and the court system would consume much time to settle the disputes.
Moreover, the budget allocated for this scheme is also not enough for 10 crore families. If the scheme becomes successful with all the beneficiaries becoming aware of it, there would be no money to run the scheme and it would collapse.
Also, the government hospitals lack the necessary infrastructure needed for the treatment. Then come the private players, with the best of infrastructure but less willingness to implement the scheme as per the plans and rules laid out by the government. Most private hospitals charge the patients for the services provided, for which they are entitled to get free treatment. There is a strong feeling among people that private healthcare is better than government healthcare. Hence, they go to the private health centres and get themselves exploited.
But after all, there are lakhs of beneficiaries of this scheme who were earlier unable to get cheap treatment. They could not afford going to private healthcare centres for their treatment, but, because of this scheme, they can receive healthcare at private hospitals where they couldn’t earlier afford to go.
How to improve the implementation: In order to make this scheme successful, the government should:
Recognize and train informal healthcare providers
Develop an online redressal forum for the patients
Conduct a test to examine the ability of practitioners associated with this scheme
Enforce strict laws that make it impossible for these practitioners to prescribe wrong medicines for their own benefit
Build new district hospitals and sanction new equipment for the hospitals
Check whether all things are on track by sending their own people as patients to hospitals
Expand the number of MBBS doctors and trained nurses and ensure their participation in this scheme.
References
Business Standards. (2019, february 22). Retrieved from
https://www.businesstoday.in/current/economy-politics/ayushman-bharat-ceo-12-lakh-people-free-treatment-scheme/story/321287.html
Economic Times. (2017, July 21). Retrieved from
https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/less-than-one-doctor-for-1000-population-in-india-government-to-lok-sabha/articleshow/59697608.cms
Times Of India. (n.d.). Retrieved from
https://timesofindia.indiatimes.com/india/health-spending-pushed-55-million-indians-into-poverty-in-a-year-study/articleshow/64564548.cms