How Ayushman Bharat unfolded during the Election Season

Ayushman Bharat unfolded during the Election Season.jpg

Is Ayushman Bharat difficult to understand? In this monthly column HE describes the piece by piece construction of nation’s healthcare system and looks at the key moments in the healthcare history.


Moving towards a universal health care system is a long term process involving both progress and regress. In India, the topic of Ayushman Bharat brings with it considerable controversy and ideological baggage. One of the major criticisms against Ayushman Bharat is that it focuses on tertiary care.  And often media reports about tertiary care provided to poor patients, but what about primary care? Last year on Ambedkar[1]  day PM Narendra Modi had visited aspiration district in Bijapur in Chhattisgarh and launched the first Health & Wellness Centre and interacted with Asha workers. Since then 15,000 Health and wellness centres have been launched providing comprehensive healthcare.

The Health of the Nation

To some April 14th is one of the most important days for the scheme. Perhaps that’s because it was the first anniversary of Health and Wellness Centres. Can we call the scheme a success? What could be the yardsticks for considering it a success or a failure? Clearly, there are long term, medium term and short term goals for the scheme. A robust IT system to hold up the scheme and providing services as planned must have been the initial targets for the policy makers. According to Dr Indu Bhushan, CEO of Ayushman Bharat,  in the medium run, the plan was to provide healthcare to 10 crore families. During an interview given to an online news portal he reminded that the long term goal was to reduce the cost of healthcare and improve accessibility and affordability of services.

The desire to put primary care above all, clearly looks understandable. National Health Authority focuses on PMJAY and Ministry of Health takes care of wellness centres. But relying purely on tertiary care would be reactive approach. Success of Ayushman Bharat is critically dependent on success of wellness centres. Tertiary care can just be one of the the tools. You also need to reach out to communities, identify vulnerable sections and help them deal with prevention of illnesses. Unless, India has a strong primary care system, which can prevent illness, provide source for referral and support after patients are discharged from hospitals, PMJAY won’t work properly.

With women voters accounting for half of the voter base, BJP have promised women that if they come back to power, that the  coverage of the Ayushman Bharat will be expanded to include all Anganwadi workers and ASHA workers.

So will the scheme be able to change the face of  healthcare sector in 3 to 5 years time? Schemes like Obama Care has faced several bottled necks. When Obama Care was launched, the website crashed  for a long time and call centre couldn’t cope with the load of calls. The employees responsible for building the website were inadequately trained, kept sloppy records and failed to identify delays according to a Bloomberg report. But that didn’t happen with Ayushman Bharat, which caters to 15,000 patients every day. Infact, authorities have been issuing three to four lakh cards every day.

 Infact, PMJAY is more of an assurance scheme than an insurance scheme, where the government is assuring healthcare services for bottom 40 percent of the population. Even though people don’t pay premium, it is still an insurance scheme.  

Currently, there are several open questions about the scheme like whether middle class and upper middle class will be covered by the scheme. Even though PMJAY covers only 40 percent of the population, several states cover 20 percent more. CGHS covers 15 percent of the employed sector. So, almost 75 percent of the population is covered by insurance.   

One of the most debated aspects of the scheme is the premium of the insurance, which varies from state to state, as it depends on the likely use of services. It depends on health seeking behaviour and cost, and it already varies across different states. Cost of services in Mumbai is more than cost of services in Trivandrum. Further, while other schemes were covering only secondary care, PMJAY covers both secondary and tertiary care. Another concern  is the reach of the scheme.

Even the cost estimate of the scheme is still not clear. There have been estimates from Rs 10,000 crore to Rs 50,000 crore. But sources note that cost per hospitalization is Rs 13,000. So, if there are 1 crore patients, then it would be 13,000 crore. And in terms of GDP, it is still a very small percentage. 

Private sector has also been integral part of scheme. So, far close to 15,000 hospitals have been empanelled in the scheme and close to half of those are private hospitals.  Several big chains like Medanta and Narayana Health has been supporting the scheme. It does make financial sense for private hospitals because the government would be offering big business to them. Infact, the rates have been fixed by a technical group involving experts from AIIMS as well as people like Vinod Paul.

Ayushman Bharat and Small Towns

But would the scheme lead to expansion in smaller towns and tier III cities? The scheme has been only running for few months and the entrepreneurs take business call only if it survives even after elections.

The IT backbone of Ayushman Bharat is National Health Stack. It is a collection of cloud-based services. Currently, the data has been used to monitor the scheme, in terms of access to services, what kind of services are being used. The data has also been used to look at fraud and abuse. In the future, it could give insights about policy implications, whether certain types of diseases are more prevalent in certain areas. 

Meanwhile, a fake WhatsApp message has been making rounds yet again as the 2019 Lok Sabha elections are underway in the country. The message is related to registration to avail the benefits of the healthcare scheme.

So, next time, you think about checking about the registration details of the scheme, please check whether its a fake website or not.