ayushman-bharat-over-five-years-later-is-the-scheme-a-success

The Bharatiya Janata Party (BJP), during the announcement of its manifesto for the upcoming Lok Sabha elections, committed to broadening the reach of the Ayushman Bharat scheme, to include individuals from the transgender community and all senior citizens over 70 years of age.

 

"Ensuring the inclusion of all senior citizens above 70 years of age in the Ayushman Bharat scheme is a top priority for the BJP," stated Prime Minister Narendra Modi on Sunday.

 

This scheme, a flagship initiative of the Central government, provides coverage of Rs 5 lakh to approximately 80 crore people across India.

 

Former Finance Minister Arun Jaitley had initially introduced it during the FY19 Union Budget announcement.

 

"In our manifesto, we pledge to extend the Ayushman Bharat Yojana to cover Senior Citizens, offering them access to free and quality healthcare," highlighted the BJP.

 

India took a significant stride towards ensuring access to quality healthcare, regardless of economic status by launching the flagship health protection scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), in September 2018. 

 

This scheme has brought the nation closer to achieving Sustainable Development Goal 3.8, which advocates for universal health coverage.

 

The scheme offers a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation to over 12 crore families (the bottom 40 per cent of the population), making it the world’s largest health assurance scheme. The scheme's success has encouraged states and union territories (UTs) to extend it to more beneficiaries. 

 

Approximately 15.5 crore families are covered under AB-PMJAY, with states’ schemes being implemented in conjunction with it. This translates to potential coverage for half of India’s population. Eleven states/UTs have aimed for 100 per cent coverage of their respective populations.

 

As the BJP announces expansion of the scheme it's important to reflect on its strengths and achievements, including its reduction of out-of-pocket expenditure (OOPE), and efficient utilisation of the government budget.

 

The scheme has sought to bridge the gap between healthcare providers and service-takers as the commercialisation of healthcare has adversely affected common people. 

 

The Ayushman Card, similar to a pre-paid card worth Rs 5 lakh, can be used for free treatment at more than 27,000 hospitals. 

 

So far, more than 24 crore Ayushman Cards have been issued. However, the scheme’s full potential can only be realised if the National Health Authority (NHA), along with its counterparts in the states aims to provide every possible beneficiary with an Ayushman Card. It should be noted that a person on the beneficiary list is not denied service if they do not possess a card.

 

The scheme boasts more than 5.39 crore admission events worth Rs 66,284 crore in the last five years. If the beneficiaries had availed the same care outside AB-PMJAY’s ambit, the total cost of treatment would have been nearly two times higher. This has resulted in savings of more than Rs 1 lakh crore.

Currently, nearly 45,000 hospital admissions are authorised daily under the scheme — roughly 31 treatments per minute. It is noteworthy that 48 per cent of treatments under the scheme have been availed by women.

 Shortcomings and Discrepancies

 

The Comptroller and Auditor General of India (CAG) made scathing observations regarding the Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) scheme in its 2023 report. 

 

The report highlighted instances where deceased patients, at least on record, continued to avail treatment under the scheme, with states like Chhattisgarh, Haryana, Jharkhand, Kerala, and Madhya Pradesh reporting the highest number of such cases.

 

Moreover, there have been discrepancies in the registration and validation of beneficiaries, including multiple registrations against the same mobile number and invalid entries in the database. These numbers included 9999999999, and similar dummy numbers.

It can be assumed that somewhere in the pipeline, to ensure higher statistics, these dummy records were created. 

 

These issues raised concerns about the misuse of public funds, which demanded investigation.

 

The CAG report also identified lapses in governance, particularly in the monitoring and oversight of the scheme. Instances where on paper, patients were admitted to multiple hospitals during the same period of hospitalisation highlight the lack of effective mechanisms.

 

Furthermore, the report noted shortcomings in the prescribed quality standards and criteria by empanelled healthcare providers, which essentially meant a failure to ensure the safety and well-being of beneficiaries.

 

The presence of invalid names, duplicate health IDs, and unrealistic family sizes and dates of birth in the database not only hinders the efficient functioning of the scheme but also raises questions about the accuracy and reliability of the data used for decision-making.

 

Certain segments continue to encounter barriers in accessing benefits under the scheme. Issues such as inadequate infrastructure and healthcare facilities in rural and remote areas, along with socio-economic disparities, contribute to inequitable access to healthcare services. 

 

It may be inferred that the Ayushman Bharat scheme faced more issues in its implementation than in its ideation. While it can’t be denied that a major populace has benefitted from the scheme, the issues raised after the revelations from the CAG’s report have raised questions about the same.

While the BJP aims to expand the scheme in case of its victory in the upcoming elections, a greater focus on the implementation of its previous promises would bring greater ease to the public.