ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846
-A A +A

Abandon Ayushman Bharat

.

The recent announcement regarding the launch of the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has raised expectations that the scheme will somehow address the extremely urgent needs regarding healthcare in the country. Expectations have also been raised because of the labelling of the scheme as the “largest health protection scheme in the world” and the promise that beneficiaries will receive ₹ 5 lakh as cost of hospitalisation.

The Jan Swasthya Abhiyan (JSA) wishes to point out that the mere assertion that the AB-PMJAY is the largest health protection scheme in the world, does not make it so, and is entirely misleading. The government’s own National Health Mission (NHM) has an outlay of around ₹ 35,000 crore, many times more than the ₹ 2,000 crore allocated for the scheme in the 2018–19 budget.

The JSA is deeply concerned about the haste with which the scheme has been conceived and announced, without regarding the negative experiences of existing insurance schemes such as the Rashtriya Swasthya Bima Yojana (RSBY). The AB-PMJAY is based on the discredited “insurance model” despite massive evidence against the effectiveness of such insurance-based schemes involving major participation of the private sector in service delivery.

The AB-PMJAY, like its predecessor schemes (RSBY and several state-level schemes), is to provide insurance cover for hospital-based care. The enhancement of cover to ₹ 5 lakh has been continually stressed while publicising the scheme. However, past experience shows that an overwhelming majority of claims under insurance schemes are actually in the region of ₹ 10,000– ₹ 50,000. Thus, the raising of the limit to ₹ 5 lakh will not translate into a windfall for patients, as we are being led to believe.

Public-funded insurance schemes like the RSBY have failed to make even a small dent in access to healthcare services. RSBY data shows that only a fraction of projected beneficiaries were actually enrolled. An even more important concern has been about the quality of services provided and clear evidence that the scheme was being milked by unscrupulous private providers to profiteer, often by performing unnecessary procedures and ignoring real needs. Horrendous reports of misuse involving the conducting of unnecessary hysterectomies in women as young as 23 years old have emerged from different parts of the country. It needs to be underlined that the scheme is being rolled out while both the central and state governments have shown no interest in implementing robust mechanisms for regulation of private medical facilities. The Clinical Establishments (Registration and Regulation) Act, passed by Parliament several years ago, is yet to be implemented meaningfully in any part of the country. At the same time, reports surface regularly of incidents of gross negligence, malpractice, and overcharging in private facilities in different parts of the country.

A majority of facilities empanelled under the RSBY were private (4,291 out of 7,226) and the same trend can be expected to continue in the new scheme. The NITI Aayog claims that the AB-PMJAY will be 17 times bigger than the RSBY, but the moot question is: How can we expect the same government to effectively run a much larger scheme, when it failed entirely in the case of the RSBY and several state-level schemes? The AB-PMJAY would thus, as earlier in the case of public-funded insurance schemes, use public resources indiscriminately to strengthen unregulated, and in several instances corrupt and negligent, private healthcare providers.

There are also serious doubts regarding the real intent behind the hasty announcement of the scheme at a juncture when several state-level elections and the national elections are just a few months away. The scheme has been announced without an adequate provision for its funding in the 2018–19 budget. By the finance ministry’s own admission, an annual outlay of ₹ 12,000 crore will be required to fund the programme, while independent estimates put the figure at around ₹ 50,000 crore. What has, however, been allocated in the 2018–19 budget is a pittance in contrast, just ₹ 2,000 crore. This raises the suspicion that the announcement regarding the scheme has more to do with attempts to score a political point, rather than a real intent in addressing urgent healthcare needs of the Indian people.

Further the scheme will only cover hospital-based care, while data shows that the bulk of expenditure that patients incur is on conditions when they are not admitted to hospitals, such as patients receiving care for tuberculosis, cancer, etc. An associated announcement has been in the pipeline to strengthen 1.5 lakh primary-level centres, now to be named “health and wellness centres.” In itself, this is welcome as it would strengthen public services.

The JSA urges the government not to view decisions regarding healthcare as opportunities for ensuring electoral success. We note that successive budgets—especially over the last four years—have contributed to the serious underfunding of the NHM, tasked essentially with strengthening public services. We demand that the government abandon plans for the AB-PMJAY. The projected annual outlay of ₹ 12,000– ₹ 50,000 crore, as per different estimates, would be much better utilised by investment in expansion of public facilities and creation of permanent public assets. Feeds by publicity agencies of the government, to news agencies, about a few hundred people who are benefiting from the new scheme are not a substitute for meeting the healthcare needs of crores of people across the country.

Jan Swasthya Abhiyan

New Delhi

Updated On : 28th Sep, 2018

Comments

(-) Hide

EPW looks forward to your comments. Please note that comments are moderated as per our comments policy. They may take some time to appear. A comment, if suitable, may be selected for publication in the Letters pages of EPW.

Back to Top