Prime Minister Narendra Modi has announced that the government-sponsored health insurance scheme – Ayushman Bharat, now rechristened Pradhan Mantri Jan Arogya Abhiyan – would now be launched in less than a month-and-a-half.

It surely seems an ambitious target. However, as the deadline looms, challenges on the ground remain immense. Since a month now, close to 7,000 hospitals have applied to be empanelled, said the scheme’s CEO, Indu Bhushan.

“We have yet not closed the application process on the portal. Meanwhile, we are in the process of vetting hospitals. If the hospital does not adhere to norms infrastructurally, they cannot be a part of the scheme,” he said.

North-eastern states and others such as Bihar have poor hospital infrastructure to begin with, he explained.

Chandrakant Lahariya, who wrote a research article in Indian Paediatrics Journal about Universal Health Coverage and the proposed insurance scheme, also emphasised on this aspect. “In India, the capacity of the States to run insurance schemes is lowest where these are needed most. The success of the scheme would also depend on how supply-deficient Indian States such as Uttar Pradesh, Bihar and the north-eastern States implement the scheme,” Lahariya stated in the paper.

Bigger hospitals not keen

Bigger corporate hospitals have chosen to stay away, citing lack of clarity, and have yet not come on board.

Furthermore, Modi said that the scheme would eventually cover all sections of society, most importantly the middle class, and thus move towards achieving Universal Health Coverage (UHC) in its truest sense.

In the initial blueprint submitted by NITI Aayog, it was proposed that the scheme would have 100 per cent coverage. This clause was later scrapped by the Ministry of Finance and the PMO citing lack of funds, and the beneficiary pool was limited to 40 per cent, a top official from the Union Health Ministry told BusinessLine.

To begin with, the scheme conveys a pro-poor sentiment for now, a sentiment that Modi has assured will be changed once the entire population is covered.

“The UHC is about everyone, everywhere, and the mechanisms for financial protection beyond the targeted 40 per cent families as in PM-RSSM, should be explored and linkage between primary and secondary/tertiary care strengthened. This should be part of the mid-term roadmap and ‘progressive universalisation’ of financial protection in India. Over a period of time, non-poor should be a part of a government scheme. While the premium for poor can be borne by the government, the non-poor can subscribe to an insurance scheme (preferably, mandatory contribution),” Lahariya explained.

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