Ayushman Bharat: Forget the politics and economics of it, India’s poor need 'Modicare' badly
Beyond the initial enthusiasm, there are major challenges the government will have to face in the rollout of Ayushman Bharat
Ayushman Bharat is too good to be real for India’s poor. Considering the implementation hurdles, there are no arguments on that. This is a high stake game for both the Bharatiya Janata Party (BJP) and the Congress party in the 2019 poll battle. But, above all these, the prospect of at least half of the population, hopefully, the poor, getting free medical care is nothing but a big revolution any country can hope for. Political and economic costs shouldn’t be the reason to kill the scheme.
If the Narendra Modi government manages to pull off 'Modicare' (so-called by a section of the media) by 25 September, this will tower above any social sector scheme this government has done in its term so far. The UPA-government too had attempted to introduce a universal healthcare scheme when Manmohan Singh was the prime minister and had initiated discussions with expert agencies, but that remained on paper due to implementation hurdles. There are similar schemes operating on a smaller scale such as Rashtriya Swasthya Bima Yojana (RSBY) that began with a Rs 30,000 cover for beneficiaries, and also underwent a few names changes to increase the cover up to Rs one lakh.
Several states, too, have run similar schemes in the past such as Aarograshri in Andhra Pradesh, Vajpayee Arogyashree in Karnataka, Bhamashah Swasthya Bima Yojana in Rajasthan, Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) in Maharashtra, Deen Dayal Swasthya Seva Yojana in Goa. Most recently, Odisha government introduced a healthcare scheme that resembles the contours of Ayushman Bharat. But despite all these, if implemented in its entirety, Modi’s promise of a universal scheme where the government is paying up to Rs 5 lakh free healthcare services to almost half of (50 crore) the country will have no parallels anywhere in the world. It will be a dream coming true for the average Indian. That’s because, despite all the state and central-level schemes, 70-80 percent of India’s population cannot afford healthcare facilities because the majority live on an annual income of a mere Rs 2-3 lakh.
Right now, India has one of the most affordable healthcare systems when compared with comparable markets such as Pakistan and Indonesia, but it is still not affordable for a large section of the country's poor.
The Global Burden of Disease study revealed in May 2018 that India ranks 145th among 195 countries in terms of quality and accessibility of healthcare, even behind neighbours like China, Bangladesh, Sri Lanka and Bhutan. Also, the government contribution to free healthcare as a percentage of GDP is almost negligible compared with most countries.
According to a healthcare expert with one of the leading consultancy firms who spoke on conditions of anonymity, the total cost of the scheme will work to around Rs 30,000-Rs 40,000 crore provided public healthcare system is equipped in terms of infrastructure and human resources.
In a country where lakhs and crores worth taxpayers money is used to bail out state-run institutions gone broke on account of fraud and poor governance, money shouldn’t be the reason to kill a revolutionary scheme that benefits a large number of India’s poor.
Of course, the cost of launching Ayushman Bharat is one of the major hurdles in the path of its implementation. What the government has allocated in the budget for the existing scheme at Rs 2,000 crore is too little. It needs to find ways to put more money on the table. This is not unachievable as 21 states have already signed up for the scheme and may have existing infrastructure. The central government needs to pay only 60 percent of the total expenses while the rest will be contributed by the state governments. According to the consultancy expert quoted above, the average premium worked out for the scheme per family can be brought down to Rs 3,000 to Rs 4,000 if the modalities are worked out properly.
Right now, the average annual premium paid by consumers for a private healthcare scheme to avail similar cover is around Rs 10,000. But these products are mostly for the upper-end customers using top rate private hospitals. If the public healthcare system is prepared to take up a major role in the scheme’s rollout, alongwith government assistance Ayushman Bharat can become a much more affordable product for the poor. This will also create a major disruption in the health insurance market forcing even big companies to think of low premium products to compete with the government scheme.
But, beyond the initial enthusiasm, there are major challenges the government will have to face in the rollout of Ayushman Bharat:
One, identifying the right beneficiaries. Ensuring that the scheme reaches the needy is a big challenge. Proper machinery needs to be instituted for assessment. This is critical since the benchmark the government is using right now—the 2011 census data—may be outdated to identify the income groups eligible under the scheme. Chances of fraudulent activities using forged documents to claim the insurance amount in connivance with the hospital authorities cannot be ruled out. This is a major risk in the rollout phase.
Second, ensuring quality treatment to patients in hospitals under the scheme is critical. This can be done only through periodic monitoring and proper assessment of the implementation. A group of medical experts and law enforcement officers must be deputed to make sure that hospitals indeed offer proper treatment to the poor and not compromise on the quality aspect to pocket the insurance money.
Third, the government needs to ensure the programme doesn’t break the back of state-run insurers roped in to rollout the plan. Presently, New India Assurance is the only leading state-run agency that offers health insurance products.
Fourth, some state governments are reluctant to join the scheme fearing loss of political points. In such cases, the centre can agree for jointly named schemes incorporating the state’s identity to generate a consensus. Ultimately, if one works out the cost-sharing, state governments that already run similar programmes are set to gain from the centre-state sharing formula. A nationwide political consensus is essential to make the scheme effective.
When Ayushman Bharat is rolled out in full scale, there will be a fiscal shock to the government to deal with. There will be political claims and counterclaims, but regardless of the political and economic hurdles, India’s poor need a universal health protection scheme badly, be it in the name of Modi or Gandhi.
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