Scaling the Ayushman Bharat Mountain

Ever since BJP swept the general elections, that too with a vast majority, there has been antici-pation about how much they would allocate for Ayushman Bharat. The expectation from entre-preneurs, economists and ordinary citizens was some reform road map. Will the government deliver its promises? A HE report.

There are many ways to examine the progress of a country, but count them anyway, the multidimensional poverty index stands out in a big way.

According to the global MPI 2019 report released this month, between 2005-2006 and 2015-2016 India lifted 271 million out of poverty.

Consider these crucial developments too. The government is also set to regulate further the medical devices industry, which is pegged at over Rs 80,000 crore, in the next five years.

Another way to look at is to also look at whether they could meet their development targets like SDGs. CAG noted that government funding on health care is far away before it can achieve the United Nations' Sustainable Development Goals (SDGs).

The number of Indians living with diabetes have also been analysed threadbare by a recent study. About one in every two Indians living with diabetes is unaware of their condition and only about a quarter manages to bring it under control, a May 2019 study has found. Rural men with low household wealth and low education levels had a higher incidence compared to other groups.

Economic remedies to inequality and insecurity?

So, there are certain things in life where you don't want a market like healthcare and education. These are areas where the majority of Indians would agree that we need to find rational ways to distribute finite resources to people.

There is a bias for rural India in the annual budget. Is it a better starting point?

The picture that emerges from The Economic Survey 2019 is that of a weak public health system. The survey uses 2016 Rural Health statistics data to show how many primary health centres satisfy Indian Public Health Standards norms. And only 20 percent of PHCs meet these norms in 2016. As per Rural Health Statistics for the year 2018, only 12% of the 25743 PHCs in India operate at quality standards which are considered essential for a health facility. The dismal picture of poor quality health infrastructure continues in other states, except a few union territories and states like Sikkim and Nagaland.

An Ameliorative Exercise?

The question in many minds after the budget is: why health didn't get any mention at all? Rs 62,659 crore has been allocated for the department of health and family welfare and Rs 1,900  crores for the department of health research- 2.3% of the entire budgetary outlay. The total proposed allocation for the health of Rs 64,999 has risen from a revised estimate of Rs 55,949 crore last year. There has been a 15 % rise in the allowance for the department of health and family welfare. However, nearly half of it Rs 4,000 crores is being added to Pradhan Mantri Jan Arogya Yojana. PMJAY saw a 166% increase from Rs 2400 crore that was estimated in 2018-2019 to Rs 6400 crore.

According to a  Zee Business TV report, several states may shift from the current trust model to pure health insurance or hybrid model for implementing the Ayushman Bharat scheme.

Further, Health and Wellness Centres also have been earmarked about Rs 1,600 crore. But one HWC requires 15 lakh, and therefore this won't be enough for 1.5 lakh centres. The BJP manifesto has highlighted the commitment to set up 150,000 HWCs by 2022. There is also another promise to increase undergraduate seats by 18,000 and PG seats by 20,000 within five years and double the number of doctors by 2024.

According to an Indian  Express report nine months after PMJAY was launched, dialysis has emerged as the most claimed package under the scheme. The rising number reflects India's hypertension and kidney disease burden.

Of the 30.78 lakh beneficiaries, 4,55,155 claims of hemodialysis have been cleared. According to government data every year, about 2.2 lakh new patients with the end-stage renal disease get added in India. It has led to an additional demand for 3.4 crore dialysis every year. Further, cataract surgeries have been pushed to the second position with 1,99,718 claims. The third most claimed procedures are deliveries.

Trajectory of PMJAY

Under PMJAY, Rs 2000 is paid per hemodialysis sitting to empanelled hospital. For deliveries amount paid is Rs 9,000 and for a cataract surgery depending on the type of surgery Rs 6,500- 10,500.

Among other diseases that feature in the list of top 10 claims are root canal treatment, cholera, or enteric fever, and acute gastroenteritis with moderate dehydration in terms of total applications, Chattisgarh, Gujarat and Maharashtra top the list.

Nine of India's 21 largest states saw a decline in their health sector performance. Five of them are also weakest according to a new report. Bihar saw the most significant reduction and Haryana saw the biggest improvement according to the second edition of Healthy States Progressive India Report, published by Niti Ayog. The report tracked and compared the states' performance in the health sector between 2015-16 to 2017-18. 

Further, at least 697 cases of irregularities in PMJAY in Uttarakhand, 11 hospitals are in the process of being slapped a penalty of over Rs 1.1 crore.

So, what is the long term perspective?

Healthcare policymaking in India has a complicated legacy. It was flattened for a very long time by the existential struggle of the healthcare sector. And now there's an opportunity to have a much more sophisticated discussion about what PMJAY is and what it means. Having access to public goods is essential for the welfare of society; otherwise, it often leads to protests like Medicare for All.