The Indian Medical Association, the country’s largest body of doctors, on Sunday stood up for universal health care directly funded by tax revenues rather than the insurance-based model through which the Centre is currently providing hospitalization cover to the poor and vulnerable.

According to the IMA, the insurance-based Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PMJAY), launched a year ago, would become too expensive to run efficiently in the long run, encourage profit maximization by large private hospitals and wipe out small and medium hospitals.

The statement came ahead of the two-day government program from Monday to mark the first anniversary of the PMJAY scheme, which provides hospitalization cover for up to Rs 5 lakh a year to over 10 crore households, or 50 crore people.

Over the past one year, over 46 lakh beneficiaries have received cashless hospital treatment under the scheme, with over half of these treatments coming in private hospitals. The hospitals empaneled under the scheme get reimbursed at rates set by the National Health Authority (NHA).

“Ayushman Bharat is a great name, but we want the government to re-conceive the scheme,” said IMA secretary-general R.V. Asokan, a physician based in Punalur, Kerala.“We’re seeking a health assurance model, not a health insurance model.” Asokan stated that the IMA had written to the government to pay for the hospital treatments directly through tax revenues, without the involvement of insurance companies between the government and the empaneled hospitals.

The PMJAY pays for nearly 1,550 treatment packages and encompasses costs of diagnostics up to three days prior to hospitalization and medicines up to 15 days post hospitalization. Senior NHA and health officials insist that the scheme has worked well with over 60 per cent treatments for high-level tertiary care.

But the IMA has emphasized concerns expressed earlier by some public health experts and economists that the PMJAY is underfunded and could affect small and medium hospitals and nursing homes.

“The package rates set under the scheme are not viable for many 20 or 25-bed small and medium hospitals — these rates encourage hospitals with large-scale, industry-style operations,” Asokan said. “We already have this trend — small and medium hospitals are vanishing, giving way to large hospitals.”

Citing the example of Kerala, he stated that several hundred small hospitals had disappeared over the past two decades, replaced through takeovers and large hospital chains. The number of hospital beds in Kerala has remained the same, about 63,000, but the number of hospitals has decreased.

The IMA also appealed for increased government spending on health. “Health officials claim PMJAY is better than China’s health schemes,” said IMA’s national president Dr Shantanu Sen. “Should we then not compare our 1 per cent (of the gross domestic product) health spending with China’s 5.5 per cent?”

A team of health economists had earlier told the government that at the current levels of funding, the PMJAY would be able to provide hospitalization services to about 30 per cent of its beneficiaries.

The IMA’s appeal for universal health care based on tax revenues mirrors the recommendations that a high-level expert group (HLEG) chaired by senior cardiologist K. Srinath Reddy had made to the Centre eight years ago.“The HLEG had come up with a revolutionary document,” Asokan said. “It is the best way to go — even now.”

The HLEG had recommended the use of tax revenues to provide universal health care through public and private hospitals with the government strengthening primary health-care services and directly purchasing tertiary services, where needed, from private hospitals.(The Telegraph)