Ayushman Bharat: Government must plug loopholes

Ayushman Bharat scheme
The Ayushman Bharat scheme, aimed at reducing out-of-pocket healthcare expenses, is facing challenges due to fraudulent practices by some practitioners.

The government’s ambitious Ayushman Bharat scheme, aimed at reducing out-of-pocket healthcare expenses, has faced challenges due to fraudulent practices by some practitioners. Several instances of fraud such as the one involving a neurosurgeon at the Safdarjung Hospital in Delhi have cost patients lakhs of rupees. The scheme has managed to reduce out-of-pocket expenditures by Indians since its launch, several loopholes in implementation have been exposed.

The Safdarjung Hospital cases highlight how critically-ill patients were deprived of the scheme’s benefits. The accused doctor is now in custody, and the incident underscores the need for proper implementation and regular checks to achieve desired results. The racket worsened the financial burdens on patients and their families, defeating the very purpose of this flagship healthcare project.

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Ayushman Bharat, a flagship scheme launched based on the National Health Policy 2017, seeks to achieve Universal Health Coverage (UHC) and aligns with the Sustainable Development Goals (SDGs). The scheme acknowledges that medical emergencies can drain savings of middle-class and poor families, pushing them into poverty.

The focus on quality of healthcare has led to the rise of government’s health expenditure, and a decline in out-of-pocket expenditure from 62% in 2015 to about 47% in 2020. However, addressing the existing loopholes is essential to fully realise Ayushman Bharat’s goals.

Instances of impersonation and non-genuine claims under the scheme have also come to light, highlighting the need for stringent checks and the use of digital aids and AI in the health ministry’s efforts.

Doctors have a key role in instilling faith among the public in India’s medical system, and it is their duty to prioritise the well-being of patients over their own financial gains. Hospitals should approach financially distressed families of seriously ill patients with empathy and understanding. Unfortunately, a lackadaisical approach has hindered the success of the Ayushman Bharat scheme.

The National Health Policy, 2017, emphasises the importance of preventive and promotive healthcare in all developmental policies and universal access to quality healthcare. Towards this objective, the government must ramp up healthcare expenditure from the current 1.2% of the GDP to 2.5% by 2025, as recommended by the Fifteenth Finance Commission.

Making Ayushman Bharat scheme a success

To improve the effectiveness of schemes like Ayushman Bharat, the system needs strengthening, and professionals should educate patients about the scheme’s benefits at empanelled hospitals. Additionally, direct transactions between doctors and patients for medical requirements should be eliminated.

Schemes like Ayushman Bharat have the potential to transform India’s healthcare system, considering its current challenges. Good health policies significantly impact a country’s economy by promoting the well-being of its residents.

The government has spent Rs 51,749 crore on the Ayushman Bharat scheme till February 2023, including health insurance coverage as well as operational costs. The scheme offers insurance cover of up to Rs. 5 lakh per family per year. The number of beneficiaries of the scheme is nearly 23.07 crore, including 4.34 crore hospital admissions with a total an expenditure of Rs 51,749 crore.

The scheme covers more than 100 million poor and vulnerable families in the country through its empanelled hospitals. The Ayushman Bharat scheme is perceived as a precursor to universal health coverage in India and has already made a significant impact on the lives of crores of Indians.

The Ayushman Bharat scheme needs to improve the quality of care at some of the empanelled hospitals and provide training to healthcare providers. The scheme is a complex one, making it difficult for beneficiaries to access it. It can be made more accessible by offering information in local languages and by simplifying the application process.

The government can increase its footprint by allotting more funds to this important scheme. It can be made more accessible by allowing people to reimburse their medical expenses. Another area for improvement is the coordination between the Union and state governments as it is a joint initiative.