Ayushman Bharat in 4 Months: Success or Failure?

There is cause for optimism and despair. PMJAY by the numbers for the readers.

How far would you go to implement a government scheme? For the government, the answer is clearly: too far.

Take Anant Kumar Roy, for example. He is a farmer from Sehara Village in Bardhaman district.  Following a prolonged illness and biopsy, he was referred to Tata Memorial Cancer Hospital. His doctor advised a surgery covered under PMJAY. However, the same month, West Bengal decided to exit the Pradhan Mantri Jan Arogya Yojana (PMJAY). The decision put not just the patient but even the National Health Agency in a problematic situation.

On January 11, Mamata Banerjee announced Bengal's decision to withdraw from Ayushman Bharat scheme. “Today, we are withdrawing from the Ayushman Bharat scheme. Now, the Centre will have to bear the entire cost of the scheme as we will no longer pay our share of the money. Why should we pay if it (Centre) takes all the credit?” said Banerjee.

The West Bengal government had initially declined to participate in the Ayushman Bharat scheme as it already had its health protection scheme called Swasthya Sathi. However, in July last year, the state government signed an agreement to implement the Centre's health insurance scheme under the joint banner 'Ayushman Bharat-Swasthya Sathi'. Following the merger of both projects in October last year, the cost for the beneficiaries was shared in a 60:40 ratio with the state government bearing 40 per cent of the value, said an Indian Express report.

Technically, after West Bengal exited the scheme, Roy was not eligible for the scheme. But after several discussions, Union Health Minister J P Nadda decided that Roy should not be denied treatment, albeit as a “special case”.

Rates of Schemes still a Significant Concern

Indian authorities are out to quash the teething issues of the scheme. But it looks like the implementation of Ayushman Bharat will not be as easy as many expected.  According to media reports, even the government hospitals have criticised the plan. They have raised concern about the rates set by the government for procedures covered under PMJAY, implemented in Karnataka as Ayushman Bharat-Arogya Karnataka (Ab-Ark) scheme.

Are Investors Moving away from the Healthcare Sector?

Interestingly, these news reports come on the heels of warnings of several industry leaders. Biocon chief Kiran Mazumdar-Shaw tweeted that Investors are moving away from the hospital sector due to capital intensive and low margin business model. "Ayushman Bharat is adding to this exodus, who will build hospitals?" she asked.

This isn't the first time that PMJAY has been mired in controversy.  Several experts have expressed their displeasure about the poor planning regarding the scheme, as private hospitals empanelled under Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) no longer have to treat a mandatory ten per cent of their patients for free, as used to be a requirement previously. K Chandrasekhar Rao, Chief Minister of Telangana-which also opted out of Ayushman Bharat scheme- also commented recently that the state-run project is much better than Ayushman Bharat.

But at this time, experts say, that the adverse effects of the state-centre rift have not seeped into public policy yet. NITI Aayog member VK Paul, Chairman of Board of Governors, Medical Council of India is a strong supporter of the scheme. He said that Ayushman Bharat had benefited more than 8.9 lakh people since its launch last year, while he was speaking at the first gathering of the All India Institute of Medical Sciences (AIIMS), Bhopal.

Is the centre looking for new partners?

Indian bureaucracy still has a competent set of experts, who can guide and advise healthcare policymaking in the right direction. National Health Authority, the apex body implementing the insurance programme the government announced that Indian Railways hospitals across the country would soon provide treatment to eligible families under the Centre's ambitious scheme. 

Maharashtra upgrades 64 PHCs to HCWs

One positive aspect regarding the scheme was the fact that  64 Primary Health Centres (PHCs) across Maharashtra have been upgraded as Health and Wellness Centres (HCWs) under Ayushman Bharat.

Further, comments of the officials of Ayushaman Bharat have been well received by the healthcare community. J Vijayakumar, CEO of Ayushman Bharat MP said that more than 13 lakh people have benefited from Ayushman Bharat scheme in the state so far. He also noted that the programme covers more than one crore 37 lakh poor and vulnerable families across MP, identified as deprived rural families and occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data.

Haryana health minister, Anil Vij, also pointed out that the state generated 3.75 lakh golden records for the project. Until January 23, about 4900 patients have been registered under the scheme, and hospitals have made about 3900 claims. The government has released four crores to the empanelled hospitals.

Even Microsoft Co-founder Bill Gates congratulated the Indian government for the achievements made by the Ayushman Bharat healthcare scheme in its first 100 days. “Congratulations to the Indian government on the first 100 days of @AyushmanNHA. It's great to see how many people have been reached by the program so far,” Gates tweeted, tagging the Prime Minister's Office.

Prime Minister Narendra Modi replied that the scheme “stems out of our commitment to provide top quality and affordable healthcare to the poor.”

What will the Budget Bring?

Currently, there is plenty of speculation that the government would increase allocation for PMJAY scheme. So, what should we expect in 2019 budget? Pundits forecast that the government will allocate a considerable amount for Ayushman Bharat in the budget.  Over the last few months, the healthcare sector has gone through a historic transformation at breakneck speed. And many think that this could inspire the government to allocate more than Rs 54,000 crores for health ministry. But, the government hasn't addressed the many comments regarding the flaws of the project raised by several healthcare organisations. And this might affect the adoption rate of the scheme among private players.