The Union Ministry of Health and Family Welfare lauded Ayushman Bharat at the end of last year. However, Indian Medical Association (IMA) president Dr Santanu Sen seems unimpressed.
“So far 33 states and [union territories] are implementing the scheme,” the Ministry said. “Treatment worth Rs 9,999.76 crore for 6,919,973 hospital admissions has been provided under the scheme. 68,106 cases of hospitalisations were availed outside the state of residence. Also 19,839 hospitals have been empanelled under the scheme and 11.51 crore scheme cards, which include state cards, have been issued to the beneficiaries.”
However, Sen has criticised the insurance-based model of the initiative. “People of India want assured health policy and not an insured health policy,” the IMA president said. “There are many hospitals in the country where patients have to buy even small things like syringes. Therefore, the government should bring a uniform universal health policy instead of schemes like Ayushman Bharat so that health policies don’t vary from state to state.”
Ayushman Bharat – officially known as the Pradhan Mantri Jan Arogya Yojana – provides health insurance coverage of Rs 5 lakh per family per year to approximately fifty crore people. The scheme has won praise from a number of observers, ranging from World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus to Nobel laureate Abhijit Banerjee to philanthropist Bill Gates. However, the initiative has also come under fire from a number of bodies.
“The government, instead of giving money to the government hospitals, is giving money to third party (i.e. insurance agencies),” said Sen. “Why? First they should provide money and infrastructure to their own hospitals. They say they provide insurance to fifty crore people but how do they decide who needs this service and what about the rest of the eighty crore population?”
The IMA president has raised similar concerns in the past. “Why should it be done through insurance companies by paying fifteen percent to them?” he queried in September last year. “There should be no insurance model. Before fixing up the package rates, before making decisions on a number of disciplines, an organisation like IMA should be taken into confidence.”
Sen also raised concerns over the exclusivity and scope of the initiative. “They are telling that they are serving fifty crore of Indians. What about the rest crore crores of Indians?” asked the IMA president. “How did they decide that only fifty crore people need this service and not the rest? Health is a state chapter. Were all the states brought into the loop? Were there suggestions duly honoured? No.”