Ayushman Bharat: A Lifeline or a Lost Cause?

Ayushman Bharat was launched in 2018 as a flagship insurance scheme by the Modi government designed to provide annual insurance coverage of five lakh rupees per family for those hailing from the most economically deprived sections of society. This comprehensive insurance scheme aims to protect the poorest of the poor from falling into catastrophic debt, which can occur due to the inability to afford necessary medical expenses, such as doctors' fees, hospital bills, treatment costs, and surgical operations. By addressing these financial barriers, Ayushman Bharat seeks to ensure that vulnerable families can access essential healthcare services without the fear of overwhelming financial burdens.

However, six years after its inception, the Ayushman Bharat scheme seems to have somewhat derailed, primarily due to a variety of reasons. To begin with, in Maharashtra, the government has empanelled a significantly higher number of private hospitals compared to government hospitals for Ayushman Bharat-related treatments. The stark reality is that private hospitals often show a marked disinterest in providing health care to economically deprived sections of our population, as their operations are fundamentally driven by profit motives. In an article published by The Scroll, many private hospitals have reported that since 2021, they have faced considerable delays in the processing of claims, along with numerous rejections and deductions in payments. Despite the government's substantial budget allocations for Ayushman Bharat, actual spending remains disappointingly low. For clarification, in the 2022-23 fiscal year, the budget allocation for the scheme was `6,412 crores; however, during the first nine months of 2022, the government released only 18% of these allocated funds. This discrepancy raises significant concerns about the scheme's effectiveness in delivering necessary healthcare to those in need.

Keeping these facts in perspective, it would make far more sense to increase the number of government-empanelled hospitals across various states and significantly improve their overall quality. As highlighted in a recent article in Economic and Political Weekly, many government hospitals in Maharashtra face challenges due to inadequate health infrastructure and poor maintenance of diagnostic equipment, resulting in a notable mismatch between demand and supply. Even more concerning, a poorly organised and corrupt system leaves the public health system in the state consistently lacking essential medications. Consequently, these public health facilities often resort to providing private prescriptions, which leads to enormous out-of-pocket expenses for patients. This unfortunate state of affairs has a devastating impact on the economically disadvantaged, further exacerbating their struggles and hardships in accessing necessary healthcare services.

Ayushman Bharat, while a significant initiative, does not extend its coverage to outpatient treatment, and it notably does not provide reimbursement for critical diagnostic tests such as CT scans and MRI scans. This limitation raises concerns about the comprehensiveness of the healthcare services offered under the scheme.

Additionally, a troubling aspect of the healthcare landscape in Maharashtra is the persistent shortage of medical professionals. Each year, approximately 7,000 medical graduates enter the workforce; however, data from the Public Health Department highlights that a staggering 14% of medical officer positions remain unfilled. Even more alarming is the vacancy rate for district health officers, which stands at 64%, while 54% of civil surgeon posts are unoccupied. Furthermore, the situation for specialists is dire, with a vacancy rate of 81%.

All these factors have to be considered when the overall effectiveness of the scheme is determined. The deprived, especially the most economically deprived sections of our society, cannot but be adversely affected by these conditions.

(The author is a private researcher. Views personal.)