The Modi government should pull all stops to make Ayushman Bharat a success because it is a gargantuan welfare scheme targeting the below poverty line (BPL) segment of the society which hitherto has been driven to either fatalistically resigning to fate or selling their properties for expensive tertiary healthcare.
It has kindled a lot of hopes like never before for this segment, and one can expect a deluge of patients availing free medical treatment under the scheme in notified hospitals. And it is here that the Modi government must be cautious---any scheme that whips up excitement and promises salvation is bound to invite frustration if for some reason it ends up in a whimper for want of implementation and last-mile delivery either generally or in the neglected pockets of the nation.
Under section 80-IB of the Income Tax law, there was income tax exemption for five years for 100-bed hospitals in non-metropolitan cities. The Narendra Modi government must bring in immediate legislation to replicate it, this time around across the country including the metropolitan cities. Since the gold card issued under the scheme is portable across the country, there is a likelihood of poor patients flocking the urban medical centers of excellence like the Christian Medical Hospital Vellore, Apollo Hospitals and AIIMS.
In matters of health, everyone wants the best. Though emergency cases would be willy-nilly catered to by the nearest hospital, patients who can afford to wait a few days and travel would prefer the safety of hospitals of repute that unfortunately are concentrated in urban areas.
Anecdotal evidence shows most of the urban hospitals are visited mostly by patients from neighboring towns and villages where good hospitals are conspicuous by their absence.
The government must carefully calibrate the tax exemption for Ayushman hospitals. All hospitals treating patients under the scheme must be exempted from income tax for five years insofar as profits from treatment of such patients are concerned. It would call for separate accounts and audit. The ones in hinterland must get a heightened tax benefit may be for 10 years if only to stop the exodus to reputed hospitals in urban areas.
The reason why people flock to reputed hospitals is the fear of charlatan doctors and hospitals, especially in the hinterlands. The government has an unenviable task of keeping them at bay. Indeed, the medical and paramedical industry has got a fillip with the launch of Ayushman Bharat, and one can expect charlatans to jump into the fray with added vigor. It is not only the patient who is turned away who gets sour and riled but also the patient who has been done in by medical negligence.
Apart from the hospitals, contributors to healthcare must also be given tax breaks. The central government, as well as state governments must set up Ayushman welfare trusts so that donations to it is 100 percent tax deductible. Such donations must also make the grade on the CSR (corporate social responsibility) touchstone. Every company is expected to spend 2 percent of its profits on CSR.
There can be no better cause than providing Medicare to the poor. Indeed, the government would need all public contributions to make the Ayushman initiative a success. Insurers pull up their socks from experience. Initially, they might have agreed for a small premium of around Rs 1,000 per patient but if the experience reveals that this is unviable, the government will not be able to sustain their interest unless the premium is increased.
It is the election year in which the Ayushman Bharat scheme has been rolled out. In the short time between its rollout and the elections, if there are large scale snafus or botched up cases, it might boomerang on the Modi government. The poor took the slings and arrows of demonetisation in their strides but they might not be as tolerant if the promised salvation from physical suffering turns out to be illusory or deficient.
(The author is a senior columnist and tweets @smurlidharan)
Updated Date: Sep 25, 2018 11:54 AM