Many states are unwilling to merge existing state healthcare models with the national one and international economists are calling it a hoax.
Many states are unwilling to merge existing state healthcare models with the national one and international economists are calling it a hoax.
New Delhi: With great pomp and fanfare, Arun Jaitley, Union Finance Minister and the Minister of Corporate Affairs in the Cabinet of India, announced the Ayushman Bharat or ‘Modicare’ health care scheme in February. With PM Modi set to launch the scheme on August 15, many issues have cropped up ranging from many states unwilling to merge existing state healthcare models with the national one and international economists calling it a hoax.
What is Ayushman Bharat or ‘Modicare’?
Ayushman Bharat is a national health protection scheme covering primary, secondary and tertiary healthcare to be launched on August 15.
The programme aims to provide free essential drugs and diagnostic services for illnesses that do not necessitate hospitalisation (outpatient care) through 150,000 health & wellness centres, as well as an insurance cover of up to Rs 5 lakh per year per beneficiary family for hospitalisation (inpatient care), both secondary and tertiary care. A PTI report said that the govt claimed that it will provide employment to 10,000 jobs will be created and over one lakh people will be skilled to become ‘Ayushman Mitras’ who will assist people to get the most out of this scheme at both private and government hospitals.
Ayushman Bharat is expected to take India towards universal health coverage, the situation when “all people obtain the health services they need without suffering financial hardship when paying for them”, to quote the World Health Organization.
To cover more than 107 million poor and vulnerable families or about 40 per cent of India’s population, the government claims that Ayushman Bharat will be the world’s largest government-funded health protection programme, and will have “a major impact on reducing out-of-pocket expenditure on health”.
It also claimed that it will provide employment to 10,000 jobs will be created and over one lakh people will be skilled to become ‘Ayushman Mitras’ who will assist people to get the most out of this scheme at both private and government hospitals.
States unwilling to merge with Modicare
Many states ruled by non-BJP governments are wary of the political implications of launching a scheme so closely associated with the prime minister’s name, they also already provide health coverage to a much larger universe of beneficiaries than what the centre is willing to provide under Ayushman Bharat. “So the states are obviously hesitant, as merging existing schemes with Ayushman Bharat will raise costs while also being a political dud,” reported CNBCTV18.
“Maharashtra has been reluctant since it already runs the ‘Mahatma Jyotiba Phule Jan Arogya Yojana’ covering 2.2 crore families when Ayushman Bharat is offering a cover for only 83 lakh families. The Kerala government is faced with a similar dilemma. The state already offers a cover to 35 lakh families when the Ayushman Bharat cover will apply to only 19 lakh families. In repeated conversations between the centre and the officials of the state on the enrollment for Ayushman Bharat, the government has been reluctant to abandon the universe currently covered,” the report added.
Economist who designed MGNREGA calls ‘Modicare’ a hoax
Development economist and activist Jean Dreze termed the soon-to-be-launched Ayushman Bharat health scheme a “hoax” as it was actually not big as it was being claimed to be. “The budget (for the scheme) for this year is Rs. 2,000 crore. Even if it is spent, it’s less than Rs. 20 per person,” he said at the launch of the book “Bharat Aur Uske Virodhabhas’, the Hindi edition of his book ‘An Uncertain Glory: India and its Contradiction’ that he co-wrote with Nobel laureate and economist Amartya Sen.
“It is projected as health insurance for 50 crore people, but it is virtually nothing, said Dreze. The Belgian-born Indian economist helped the UPA government in the first draft of Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA). Jean Dreze became an Indian citizen in 2002 and is an honorary Professor at the Delhi School of Economics.
The reality of Healthcare in India under Modi rule
India spends only Rs.3 for the health of every Indian every day.
“Since the BJP-led National Democratic Alliance (NDA) government came to power, there has been a 20% cut in the budget for the National Health Mission and a 10% cut in the allocation for the Integrated Child Development Services (ICDS) programme. The worst affected is the National AIDS Control Programme, now in its fourth phase of implementation. The AIDS programme will receive Rs. 300 crore less funds next year. The government has “not just belied its promises, it has done precisely the opposite”, wrote Jayati Ghosh, professor of economics at the Centre for Economic Studies and Planning, Jawaharlal Nehru University, in the latest issue of the British Medical Journal.
Out-of-pocket (OOP) health expenses drove 55 million Indians–more than the population of South Korea, Spain or Kenya–into poverty in 2017, and of these, 38 million (69%) were impoverished by expenditure on medicines alone, according to a new study released in June by the Public Health Foundation of India (PHFI), an advocacy group.
The amount India spends on public health per capita every year is Rs 1,112, less than the cost of a single consultation at the country’s top private hospitals–or roughly the cost of a pizza at many hotels. That comes to Rs. 93 per month or Rs. 3 per day.
At 1.02% of its gross domestic product (GDP)–a figure which remained almost unchanged in nine years since 2009–India’s public health expenditure is amongst the lowest in the world, lower than most low-income countries which spend 1.4% of their GDP on health, according to the National Health Profile, 2018, released by union minister for health and family welfare, J P Nadda, on June 19, 2018.
Existing schemes from UPAs rule
In 2004, when UPA came to power, expenditure on public health was around Rs 7,500 crore. It quadrupled to Rs 27,000 crore before Modi came to power in 2014. “In the beginning of UPA’s regime, the National Rural Health Mission (NRHM), known to be “the most ambitious rural health initiative ever”, was initiated. The NRHM was formed to provide effective healthcare delivery to our rural population, especially women and children. Data from 2014 showed that in the last 10 years, infant mortality rate (IMR) has come down from 58 per 1,000 to 44. This is further set to decline sharply. During the National Democratic Alliance’s regime, the IMR declined at a snail’s pace of 1.3% annually, whereas now this deceleration is happening at 6.4% per annum,” reported Economic Times in 2014.
The Universal Health Care Scheme that UPA II partially rolled out towards the end of 2013 had at its core 50 essentials medicines, some devices and diagnostics to be given free. The Modi Government stopped that in 2014 and then started the PMBJP (low-cost pharmacy scheme) with ambitious plans to scale upto 6 lakhs outlets. It was a resounding failure with just 3000 of them at the end of 2017. So, they have gone back to the free scheme without contours being drawn under the new dispensation.
The government should rope in all stakeholders and even if the pharma, devices and diagnostic companies are told to contribute the 2% CSR into the government scheme, it could go a long way. Even in AIIMS, the patients have to buy even sutures themselves.
There is actually no shortage of resources. Both in primary health and primary education. There is limitless demand, backed by money, albeit at low price points. There is enough private sector capital, only some of it from philanthropic funds, willing to invest in a scalable hub and spoke models using AI techniques. It will not just change the lives of citizens, but will provide employment chiefly to women.
It is not the scheme itself which is faulty or ill-advised, lack of implementation and monitoring could very well make it another healthcare nightmare and scam of gargantuan proportions. It is possible that another fundamental human right could become a political commodity in the wrong hands.
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Rs 3: Amount India Spends Every Day On Each Indian’s Health
Health Expenses Pushed 55 Million Indians Into Poverty In 2017
