States need to have the wherewithal to make a success of Ayushman Bharat

Ayushman Bharat, the mega healthcare and insurance scheme and the largest globally, has been launched by prime minister Narendra Modi from Ranchi in Jharkhand. The government and the prime minister himself have invested much in the ambitious scheme. While it is being hailed by health experts, there are doubts about how successful it will be and these have been triggered by five states that have refused to roll it out.

Dubbed as ‘Modicare’, the scheme is massive in size and reach. Over 50 crore people have been targeted to cover with healthcare services that will be cashless. Secondary and tertiary healthcare treatment that requires hospitalisation is being made available to the most poor and vulnerable sections, the two quintiles that determine eligibility for Rs 5 lakh medical insurance cover. Socio-economic caste census of 2011 data will serve as the basis to identify and provide health services seamlessly in 444 districts across 27 states and UTs to begin with.

However, it is also a fact that all 50 crore people will not benefit from the scheme right away. The scheme is being launched in phases. It is important to listen to chief ministers who are not convinced about it. The Odisha government, against which the prime minister launched a sharp attack for not joining the programme, says the state’s own Biju Swasthya Kalyan Yojana covers a larger part of the population than Ayushman Bharat and provides Rs 7 lakh cover to women, which is more than the central scheme. Other states that have rejected it are Kerala, Punjab, Delhi and Telangana.

A key point has been raised by the Kerala finance minister Thomas Isaac. He has pointed out that under the existing Rashtriya Swasthya Bima Yojana (RSBY), the benefit was Rs 33,000 for a premium of Rs 1,250 while under Ayushman Bharat, the benefit is Rs 5 lakh for a subsidised premium amount of Rs 1,110. This raises an important question: do states have the wherewithal to support Modicare?

It needs to be acknowledged that for Ayushman Bharat to be fully operational, another 2,500 hospitals and quality medical care centres will have to become operative in the next two years in tier II and tier III towns. This, by all accounts, is a Herculean task. The biggest challenge will be to monitor the quality of hospitalisation services. Given the less than optimistic track record of even best healthcare brands, a big possibility is that these hospitals may jump in to make the moolah at the cost of vulnerable people.

On the other hand, if the government at the Centre and states are successful in delivery of healthcare services, the political dividend that Modi derives will be huge in the next general elections. This apart, Ayushman Bharat could set the benchmark in terms of quality, size and design apart from implementation for other social services campaigns. The initial hiccups are bound to be there. But, 6 months down the lane, results may be there for all to see and analyse. While Ayushman Bharat expands over the next few years, a simultaneous campaign in preventive care may also have to be undertaken.