A public policy of the scale of Ayushman Bharat is bound to have political implications. More than anybody, the Prime Minister knows this.
For a government which assumed office amidst high expectations, the level of satisfaction with Narendra Modi-led National Democratic Alliance (NDA) regime over its governance record differs from people to people. Depending upon whom one talks to the responses vary hugely from enthusiastic to lukewarm and downright cynical. It is undeniable, however, that a record number of schemes have been launched in the last four years. Some schemes initiated by previous governments have been brought into frameworks, where outcomes become measurable on well-defined parameters. Besides its massive push for manufacturing, infrastructure development, financial inclusion and digitising governance, if there is one thing which stands out remarkably to its credit, it is Modi government’s focus on social welfare.
With toilets, gas and electricity connections, bank accounts and housing subsidies - India is not only seeing an unprecedented social welfare drive, the delivery has reached the intended nooks and corners of the country, despite the Indian babudom notorious for its inefficiency and corruption. The success of these schemes can be attributed primarily to effective use of socio economic caste census (SECC) which uses deprivation indicators to identify beneficiaries instead of below poverty line (BPL) mechanism - vulnerable to data inaccuracies, data manipulability and corruption.
Using the same SECC data, Prime Minister Modi has announced, arguably, the most ambitious of all welfare schemes, Pradhan Mantri Jan Arogya Abhiyaan, also called Ayushmaan Bharat, on 15 August this year. A staggering 10.76 crore families covering roughly 50 crore Indians are the intended beneficiaries. Also being touted as Modicare, this is the largest government funded healthcare programme in the world. Under the scheme, beneficiaries are entitled to Rs 5 lakh worth of healthcare per annum, including pre and post care, at empanelled hospitals irrespective of their family size.
The inclusion of treatment for continuing diseases is an improvement on the existing mediclaim insurance model. Talks are going on between Health Ministry and Labour ministry to extend the benefit of Ayushmaan Bharat to subscribers of Employees Provident Fund Organisation (EPFO). The scale of Modicare was so huge that many healthcare experts and economists had doubts about its implementation.
For a country with an average household income of around Rs 165,000 per annum, a large number of families go back by a year or more if there are unexpected medical bills to be paid. With a poor ranking on affordability of medicare index (145th in the world), it isn’t uncommon to see people selling their land or mortgaging their properties to bear the cost of hospital expenses. It is no brainer, therefore, that besides a noble social welfare initiative, Modicare promises to be rewarding politics also.
The launch and successful implementation of various social welfare schemes has already helped the BJP breach boundaries of its traditional ‘upper caste’ base. Along with demonetisation, social initiatives like Swachha Bharat, Ujjwala, Saubhaagya, Ujala and Pradhan Mantri Awas Yojana have radically changed the demography of BJP’s support base. Hitherto a middle class, urban, ‘upper caste’ party, the BJP now finds favour across the socio-economic spectrum. Ayushmaan Bharat, if rolled out fast and effectively, has the potential to be a game changer in the forthcoming Lok Sabha elections.
Quite naturally, the BJP is keen to roll out the scheme as early as possible throughout India. The fact that the party, along with its allies, has governments in 21 states will make things easier for it. Fearing the same, probably, some states governed by non-National Democratic Alliance (NDA) parties, are hesitating to cooperate.
According to a report in the Economic Times, none of the seven states governed by non-NDA parties has signed the memorandum of understanding (MoU) with Centre so far. Odisha has refused to sign the MoU and plans to launch its own healthcare scheme on similar lines. Citing several reasons, the Aam Aadmi Party (AAP) government in Delhi has also been dragging its feet. Although on the face of it, the party cites inadequacy of data from the 2011 census to signing the MoU, top officials have told India Today that AAP’s main objection is with the name. It wants the scheme to be named as Mukhya Mantri Aam Aadmi Swasthya Beema Yojana - Ayushmaan Bharat. The demand is unjustified as it will be the centre which will be the major contributor to the funds in the ratio of 60:40.
In case of some other states there are other reasons for the delay. For instance, some states like Gujarat and Chhatisgarh want to form trusts to bankroll the beneficiaries along with insurance companies. The reason for this might be the worry that insurance companies either reject claims or take inordinate time to settle the claims.
Ayushmaan Bharat also marks a departure in Modi’s politics. Both, as chief minister of Gujarat and as prime minister so far, he has favoured policies which empower the citizens. Ayushmaan Bharat signifies his embrace of the entitlement model, even if it is a one off occurrence as yet. Given the pathetic state of public health care system where primary health care centres suffer from lack of basic infrastructure and acute shortage of doctors and nurses, the programme might well be a better and quicker way out.
Predictably, noises that Modicare might benefit private hospitals inordinately have already begun to appear in editorials and opinions in magazines and newspapers. There are demands that government must focus on strengthening public healthcare rather than allow private hospitals to make money. However, socialist pique with private profits should be the least of government’s worries. The real challenge for the government would be to ensure swift access to beneficiaries, quality healthcare at competitive costs and minimal leakages in the system.