The launch of the Pradhan Mantri Jan Arogya Yojana in Ranchi, Jharkhand, on Sept. 23, 2018. (Photograph: Health Ministry/Twitter)

Ayushman Bharat: All You Need To Know About The Pradhan Mantri Jan Arogya Yojana

Prime Minister Narendra Modi launched the government-funded health insurance scheme, the Pradhan Mantri Jan Arogya Yojana, in Ranchi on Sunday. The plan is part of the government’s Ayushman Bharat umbrella policy for healthcare. The inauguration of the country’s largest health insurance scheme comes a month after a pilot programme was announced by the Prime Minister in his Independence Day address on Wednesday.

In addition to the insurance plan, under Ayushman Bharat, the government also aims to open 1.5 lakh health and wellness centres by 2022, which would be equipped to treat diseases including blood pressure, diabetes, and cancer. The Prime Minister launched 10 health and wellness centres in Jharkhand on Sunday. The first such centre was inaugurated by him in April.

Here’s all you need to know about the programme:

Who It Covers, What Ailments It Covers

The mission will cover 10 crore families, including existing Rashtriya Swasthya Bima Yojana beneficiaries and those part of similar schemes in the participating states.

It covers 1,354 medical and surgical packages categorised under 25 specialties such as cardiology, neurosurgery, oncology (chemotherapy for 50 types of cancers), burns, among others. Patients can’t avail surgical and medical packages at the same time.

Private Hospitals Find Modi’s Health Insurance Pricing Unviable

Calling the pricing unviable, private hospitals threatened to stay away from the Prime Minister’s health insurance scheme that will cover more than half-a-billion Indians.

The Indian Medical Association, a doctors’ lobby that agreed to bring small and medium hospitals on board, said the rates of medical procedures under the scheme were “unscientific, non-viable and will compromise on patient safety”, according to a June 22 letter to NITI Aayog.

Beds In Rural Areas, Pricing Are Biggest Challenges: Ayushman Bharat CEO

The biggest challenge to the Narendra Modi government’s ambitious plan to provide healthcare to 10 crore families will be the availability of hospital beds in tier-II and tier-III cities and in rural areas, Indu Bhushan, chief executive officer of Ayushman Bharat told BloombergQuint.

We are hoping and expecting that we’ll find a middle ground. This is just the beginning and we’re putting a system in place for cost methodology.
Indu Bhushan, CEO, Ayushman Bharat

Rs 3: What The Government Spends Every Day On Each Indian’s Health

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 percent of its gross domestic product–a figure which remained almost unchanged in nine years since 2009–India’s public health expenditure is among the lowest in the world, lower than most low-income countries which spend 1.4 percent of their GDP on health.

Most States Opt For Trusts Amid Rush To Roll Out Modicare

Most states have opted to set up subsidy pools to fund Prime Minister Narendra Modi’s health insurance scheme that will cover more than half of Indians, as insurers stayed away because of pricing concerns and officials rush to meet the Aug. 15 deadline.

Twenty out of the 36 states and union territories will create non-profit trusts to pool in subsidy contributed by central and state governments, according to the National Health Agency.

65 Lakh Families Identified For Modi’s Health Insurance Missing

Even before Prime Minister Narendra Modi’s health insurance scheme was rolled out for more than half a billion people, India found about 6 percent families missing during surveys conducted to curb the possibility of ghost beneficiaries.

The National Health Agency didn’t find 65 lakh of the 10.74 crore households that will be covered for Rs 5 lakh a year, Indu Bhushan, chief executive officer of the implementing authority, said in an emailed statement to BloombergQuint. The beneficiaries were selected based on the seven-year-old socioeconomic caste census.

Is Modicare Too Cheap To Provide Quality Healthcare?

The Indian Medical Association, the biggest body of doctors in India, finds pricing of procedures under Prime Minister Narendra Modi’s national insurance scheme inadequate. That’s triggered a debate if Aayushman Bharat will achieve its intended objective.

The rates are far too low to provide quality treatment to patients, Vinod Kumar Monga, honorary finance secretary at IMA, said in an interview to BloombergQuint.

The National Health Stack: An Expensive, Temporary Placebo

On July 6, the NITI Aayog released a consultation paper to discuss “a digital infrastructure built with a deep understanding of the incentive structures prevalent in the Indian healthcare ecosystem”, called the National Health Stack. The paper identifies four challenges that previous government-run healthcare programs ran into and that the current system hopes to solve.

The National Health Stack is meant to be designed for and beyond the Ayushman Bharat Yojana. Unfortunately, though, India’s healthcare regime has long been in the need of severe repair, and even if the Ayushman Bharat Yojana works optimally, there are no indications to show that this will miraculously change by their stated target of 2022.

Data’s Sake, A Manmade Health Hazard

The National Health Stack envisages the creation of a unique ID for registered beneficiaries in the system — a ‘Digital Health ID’. Upon the submission of a ‘national identifier’ and completion of the Know Your Customer process, the patient would be registered in the system, and a unique health ID generated.

This seemingly straightforward process rests on a very flimsy foundation. The base entry in the beneficiary registry would be linked to a ‘strong foundational ID’. Extreme care needs to be taken to ensure that this is not limited to an Aadhaar number.

If Patients Aren’t The Winners In The National Health Stack, Who Is?

No mention is made by the NITI Aayog about any improvement in the actual infrastructure to treat patients – on better primary healthcare centres, more doctors, more dispensaries or free medicines. As with the gold rush, it wasn’t the miners who struck gold and became rich, it was the saloons, brothel keepers, hardware merchants and others who supported the gold miners who made their fortunes. Perhaps this is it – the NHS is just another gold rush and if the patients aren’t the winners, we must ask – who benefits? Is it worth it? Shouldn’t we expect something better?