Updated: Feb 5, 2022
Critical Analysis of Ayushman Bharat Scheme
Analysis by: B.S Ashish
i. Pitfall: Limited to secondary and tertiary care.
In a country where primary healthcare has been underperforming due to the lack of funding and resources, neglecting out-patient expenses and general health check-ups while devising national health schemes is not the way forward. The government, although burdened with the COVID-19 health crisis at the moment, must think long term and try to improve primary healthcare services than ensuring secondary and tertiary healthcare services for those below the poverty line (BPL). In a research study conducted by the National Institutes of Health, it was observed that around 75% to 85% of the general population in any region require primary healthcare every year; while 10% to 15% require secondary care and only 5% to 7% require tertiary healthcare services. It should also be noted that if quality primary healthcare services are provided to people, the number of patients in need of secondary and tertiary healthcare services automatically reduces as the ailment is detected and cured before it gets severe. Therefore, implementing schemes that only cover secondary and tertiary services in India when it has not even reached close to ensuring Universal Primary Healthcare is not feasible and advisable.
ii. Pitfall: Tie-ups with insurance companies.
In India where healthcare is decentralised, roping in insurance companies to meet with the expense of secondary and tertiary healthcare services of those BPL might not end up in favour of the general public as insurance firms are profit-oriented and not philanthropically motivated. While Ayushman Bharat is a national policy, state governments have an equal role to play in terms of implementing the policy, empanelling government and private hospitals and negotiating with insurance agencies. Many experts believe that state governments might fail to tacitly negotiate with these firms due to their clout and high levels of corruption among government officials; and therefore, stray away from the main motive behind this policy. “Assurance of quality primary healthcare facilities and services is more important for Indians than the insurance for secondary and tertiary healthcare services they might obtain,” expressed Dr H Sudarshan, a health expert and advisor to the Government of Karnataka on implementing the Vajpayee Arogyashree Programme.
iii. Suggestion: Seek cooperation with quasi-governmental and non-governmental organisations committed to the cause of facilitating quality healthcare services to people
Many non-governmental organisations such as Smile Foundation, Missionaries of Charity (MoC), Doctors for You (DFY), Rural Health Care Foundation (RHCF), Oxfam India and Commonwealth Human Rights Initiatives (CHRI) have played a pivotal role in ensuring quality primary healthcare services to people in rural and tribal areas where the rule of law and the reach of the government is minimal to none. The government must systematise the cooperation between these non-governmental and civil society organisations and governmental agencies in order to facilitate quality healthcare facilities at affordable prices. Instead, the recent controversy regarding the cancellation and suspension of FCRA licenses of many such NGOs by the Ministry of Home Affairs (MHA) suggest that the government is threatened by the functioning of these NGOs and looks at them as adversaries rather than supporters of the same cause. Union and state governments must keep in mind that these NGOs are far more efficient in addressing the healthcare concerns in remote areas that are often out of the radar of the government, and must cooperate with them and support their functioning rather than feeling threatened by their existence and creating obstacles for their service.
Smarinita Shetty & Rachita Vora, “Dr H Sudarshan on getting it right with Ayushman Bharat,” India Development Review (IDR), 30 August 2018. https://idronline.org/dr-h-sudarshan-on-getting-it-right-with-ayushman-bharat/?gclid=EAIaIQobChMI2M-txpi09QIVVh0rCh00wg8REAAYASAAEgKkCfD_BwE
Nisha Gupta, “Primary Healthcare in India – solutions for change vis-à-vis Sustainable Development Goals,” Smile Foundation, 29 February 2020. https://www.smilefoundationindia.org/blog/primary-healthcare-in-india-solutions-for-change-vis-a-vis-sustainable-development-goals/?gclid=EAIaIQobChMIiYeHmpq09QIV_plmAh0ZfABYEAAYBCAAEgLJwPD_BwE
Shawin Vitsupakorn, Wenhui Mao & Ipchita Bharali, “Early lessons from India’s health insurance scheme, Pradhan Mantri Jan Arogya Yojna,” Brookings, 29 April 2021. https://www.brookings.edu/blog/future-development/2021/04/29/early-lessons-from-indias-health-insurance-scheme-pradhan-mantri-jan-arogya-yojana/
Anup Karan, Winnie Yip & Ajay Mahal, “Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare,” National Institutes of Health: US National Library of Medicine, May 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408909/
Leiyu Shi, “The Impact of Primary Care: A Focused Review,” National Institutes of Health: US National Library of Medicine, 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820521/