PM Modi’s flagship healthcare initiative aims to impact 50 crore people, Modi Care has a long way to go in order for the scheme to function optimally.
This is the idea, the sentiment that PM Narendra Modi tapped into, ‘The Pradhanmantri Jan Arogya Abhiyan and Ayushman Bharat Yojana will cover 10 crore families of the country. In the coming days, the people from lower middle class, middle class and upper middle-class income groups can also access health care services from these two programs.’
But did it?
It had to cater to 50 crore people and 30 lakh people have availed the scheme till now.
That was a bold statement to make. It could serve as the saving grace for people who could not afford healthcare. However, that was not all that it was limited to. People who were earning enough to be categorized as middle class could also avail this scheme. Everyone came under the scheme’s ambit. Previously launched Rashtriya Swasthya Bima Yojana (RSBY, 2008) was subsumed when this scheme was made operational.
Poor, deprived rural families and identified occupational category of urban workers’ families are the ones this scheme aims to help.
As per (SECC) 2011 data, 50 crore people will be covered as per this scheme.
A cashless and paperless process at public hospitals and empanelled private hospitals ensures ease for all beneficiaries.
Benefits: What are you entitled to?
Premium and charges for hospitalisation expenses need not be paid and are exempted. Pre- and post-hospitalisation expenses are also included. ‘Ayushman Mitras’ will assist you and coordinate with beneficiaries and the hospital.
They run help desk, check documents to verify eligibility, and enrolment to the scheme. These benefits are not bound by physical demarcations within the country.
However, after this scheme was launched and made operational, it faced more than its fair share of criticism.
Economist Amartya Sen too found the efficacy of the scheme to be questionable. ‘Old wine in a new bottle’ was how it was described.
Though the scheme boasts to have helped around 26.25 lakh people since its inception, there’s a long way to go in order for the scheme to function optimally. There are several challenges that need to be addressed.
Still a long way to go
Firstly, the efficacy of the scheme could be on the basis of outcome measures the quality of care. That could be in terms of structure, process and outcome. This can help ascertain the impact of healthcare provided.
Secondly, insurers are different in different states. This is extremely counter-productive in some cases because it takes away from the intended purpose of the portability of the scheme.
In Budget 2019
In Union budget 2019, the government increased its allocated funds to Rs 6,400 crore. The government plans to cover 10.74 crore families with an annual healthcare cover of Rs 5 lakh, 3.45 crore people have already been issued e-cards for the scheme.
Besides the 15,224 hospitals that have already been empanelled, 1.50 lakh Health and Wellness Centres are planned to be set up. 75 new medical and post-grad medical colleges are lined up and waiting to be opened.
The Infrastructure problem
The ideation of the scheme is a commendable vision but the implementation of the scheme is problematic.
The role that each state has played in the betterment of their healthcare over the years has played a role in the success of Ayushman bharat. States like Kerala and Tamil, who have ranked the best in terms of healthcare, have thriving healthcare systems. However, states like Chhattisgarh and Bihar, who have not focused on healthcare have extremely poor infrastructure.
This has primarily been because of the spending of each state on healthcare. For the poorer states, the people living there turn to the states having better infrastructure. This means the inflow of patients in the richer states can affect the quality of healthcare imparted.
Moreover, the cost of their treatment is borne by the poorer states, which in turn are getting no better in terms of their infrastructure. This problematic loophole is further impacted by the lack of doctors.
In short, the lack of qualified medical professionals and the lack of collusion of the states with the centre have only resulted in a scheme that could have been. But that is not to say that all is over, there is still time to rectify these issues. The only question that remains is – how?