I have failed to identify the Ayushman Bharat beneficiaries. The government is surely proceeding nonetheless. Now, I wanted to understand what and how will the government benefit the non-existent beneficiaries. I looked at some of the execution details for Ayushman Bharat and came up with some basic queries:
Why Ayushman Bharat is not for the whole of India, all Indians
The government has budgeted Rs 2000 Cr for Ayushman Bharat 2018-19. For the intended beneficiary number of 50 Cr, it comes to Rs. 40/- per person. Yes, the government has budgeted a grand sum of Rs. 40/- per person for health coverage of Rs. 5 lacs. This Rs. 40/- per person is inclusive of back-end manpower costs, IT platform, administration costs, the salary of Ayushman Mitra etc. Wonder what would the exact amount be that will be paid for the actual health costs?
Niti Aayog claims that the budget for Ayushman Bharat shall rise to Rs 10000 Cr in the next few years. This comes to a majestic sum of Rs. 200/- per person for health coverage of Rs. 5 lacs.
I understand that insurance is based on the premise of healthy people who shall not avail the benefits of the coverage vis-a-vis the ill people for the multiplier effect. However, Rs. 40/- per person is enough for what?
If the government and her officials believe that their budget is sufficient for successful Ayushman Bharat execution, why not extend it to the whole of India? Why limit it to just 50 Cr people? Surely, if the government thinks that 2000 Cr is enough for 50 Cr Indians, 4000 Cr should be good enough for 100 Cr Indians.
Ayushman Bharat provides secondary and tertiary care services
It is an open secret that doctors do not exist in rural India, but the quacks. Now, if there is no primary care service available for referral to secondary and tertiary care, what is the patient supposed to be doing? The super-speciality hospitals are not meant for the first-stage diagnosis. Who is going to do this for the beneficiaries of Ayushman Bharat in rural India?
Expenses for the transport, diagnostic tests, pre and post-operative care
Suppose, somehow, the ill Ayushman Bharat beneficiary has got herself checked, diagnosed and got referred for the secondary and tertiary care. Now, let us figure out how the destitute/primitive tribal groups/beggars etc are going to pay for the transport to the hospital and the diagnostic tests before the hospital admits them.
Ayushman Bharat scheme does not budget anything for this. The government is saying that the sick person can be operated upon for free, just that there is no support for the sick person to come and go and during the process.
Ayushman Bharat replaces the Rashtriya Swasthya Bima Yojana (RSBY)
RSBY in her erstwhile form was also a government-run health insurance scheme for the poor Indian people. It provided for cashless insurance for hospitalisation in public as well private hospitals. The sum insured was Rs. 30000/- which has now been increased to Rs. 5 lacs in Ayushman Bharat.
What could have been the logic for the increase in the insurance sum? Did the government come across people dying/left unattended by the hospitals as the insurance sum was limited to Rs. 30000/- per person? I have not seen any news of this sort. In fact, RSBY was a dud. What has Ayushman Bharat done to avoid such a future?
I have copy-pasted below a quote from Thomas Isaac, the Kerala Finance Minister (I cannot check the veracity of the quote myself, I have not come across any reply from the government of India either contesting the quote). “Total claims under RSBY so far is 120 lakhs. Kerala accounts for 53 lakhs. Kerala with a population share of 3 per cent accounts for 42 per cent of the claims – a sad commentary on implementation”.
Ayushman Bharat does not cover 100% of the secondary and tertiary care. 100% of the hospitals are not empanelled
Ayushman Bharat covers almost all of the secondary and tertiary care, but not all. A large number of hospitals will be empanelled but not all (home page of Ayushman Bharat – abnhpm.gov.in gives a blank response for this link).
When the government itself does not know the names of the hospitals, how will the beneficiaries ever know? How will the destitute know which ailment is covered and which is not?
I can go further picking holes in the Ayushman Bharat execution, but that is not the point.
The point remains that the government is clueless about the execution of what could actually be a good scheme. Again, the country will be let down.
A parallel narrative on how the real Ayushman Bharat should be.