While the Narendra Modi government celebrates the success of Ayushman Bharat, medical professionals working with poor patients state that the poor are being charged less at the expense of private hospitals. At the outset of the new year, the Modi government had declared that about 6,85,000 patients had availed free treatment within the first 100 days of the rolling out of the scheme. However, doctors and former officials say that the claim seems to be full of flaws and would likely backfire politically.

Private hospitals empanelled under Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) no longer have to treat a mandatory ten per cent of their patients for free, as was the requirement previously.

Former Indian Medical Association (IMA) President, Dr KK Aggarwal, a noted cardiologist and Padma Shri awardee, said “Ten per cent of all the work that hospitals did was supposed to be free-of-cost. Under the Ayushman Bharat model, they will now get some amount, so hospital beds will be full.”

Dr Aggarwal mentioned that the government’s own erroneous planning process is keeping the PMJAY from reaching its potential. He stated that the biggest problem was a lack of transparency around the scheme. He added that several crucial things about the scheme were not looked at properly.

Dr Aggarwal further said, “It hasn’t caught up the way it should have been, if it were devised keeping just the 2019 elections in mind.” He added, “We sponsor heart surgeries for many patients who don’t have an Ayushman Bharat card. It is not reaching the people the way it should have.” He believes that the criteria for identifying persons under PMJAY-AB are flawed. He asks as to why only those covered under the socio-economic caste census (SECC) should be eligible to avail the benefits of Ayushman Bharat. He adds that this has left millions of poor people without cover.

The IMA has argued that there is no need for a different slab under Ayushman Bharat, and the rate slabs followed must be those of Employees’ State Insurance (ESI) and the Central Health Government Scheme (CGHS).

Over 50 per cent of the poor will be covered if the ESI is expanded to include employees working in the group of less than 10 workers, claims Dr Aggarwal.

The finances of Ayushman Bharat, which has overruled other healthcare schemes in the states, don’t seem to quite stack up. Dr Aggarwal stated that the biggest misnomer is that this is a Rs 5 lakh scheme per family per year.

“The government isn’t contributing more than Rs 1,500 for every person enrolled under Ayushman Bharat. The government contribution was apparently higher under different schemes that Ayushman Bharat superseded,” says Dr Aggarwal.

At the time of presenting some vital data on Ayushman Bharat, Dr Vinod Paul from the NITI Aayog, had declared that certain medical procedures were reserved only for public hospitals.

The lower Ayushman Bharat rates that the empanelled hospitals would get once they are on board seem as a major concern, as per government officials.

At the time of its launch, Prime Minister Narendra Modi had announced that about 13,000 hospitals were empanelled under the Ayushman Bharat. The majority of these were government hospitals, as the private hospitals are still doubtful about it.

Dr Aggarwal is of the opinion that all the problems will get sorted if the government passes an ordinance to bring health under the concurrent list. Currently, it is a state subject. (National Herald)