The inadequacy of public healthcare in India is a well-acknowledged fact. Public healthcare expenditure as a percentage of GDP at around 2 per cent, places India among the underdeveloped economies. According to the World Bank, proportion of out-of-pocket expenditure on healthcare in India, at 50.59 per cent, is the highest among emerging economies. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which promises health insurance cover of ₹5 lakh per year to low-income households, therefore needs greater attention, to compensate for the deficit in public healthcare facilities. But a recent CAG audit report shows that there are serious snags in the implementation of the scheme.

The problems in the Ayushman Bharat scheme stem from the way the database of beneficiaries has been constructed. The database has 7.87 crore beneficiary households. But the identification of beneficiaries is based on the Socio-Economic Caste Census (SECC) of 2011, which could be irrelevant by now. Also, though beneficiaries had to be matched with the SECC in the online portal, the CAG audit shows that such matching was not done and registrations and rejections of applications was done in an arbitrary manner. This has resulted in invalid names and dates of birth, duplicate IDs and unrealistically large households. In Tamil Nadu, 4,761 registrations were made against seven Aadhaar numbers. Such lapses not only result in the needy getting deprived of the benefits of the scheme, it is also pointing towards financial frauds being committed through fake IDs and claims.

There is an urgent need to reconstruct the Ayushman Bharat database and issuance of fresh IDs and cards to all beneficiaries, based on their Aadhaar details. In States where existing state health insurance schemes were subsumed into the Centre’s Ayushman Bharat scheme, new cards need to be provided. This needs to be accompanied by a national awareness campaign so that those not aware of this scheme too onboard and avail of the benefits.

The other critical issue highlighted by the CAG audit is the malpractices in empanelling hospitals and shortage of healthcare infrastructure, doctors and equipment in many States and UTs. The current set of healthcare providers empanelled with Ayushman Bharat scheme need to be reviewed and fresh registrations issued. The report states that many of the healthcare providers did not fulfil the minimum criteria for infrastructure and quality standards prescribed; this is not acceptable. Another problem is that private sector hospitals do not want to get empanelled in the scheme due to the delayed payouts and other glitches. Offering some fiscal incentive to private hospitals agreeing to be part of the scheme could perhaps work. The problem of inadequate health infrastructure is almost endemic. Hospital staff or government employees found defrauding beneficiaries should be penalised severely.

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