‘Ayushman Bharat or proper treatment?’

Patriot was curious to find out why the Delhi government is not accepting the Centre’s Ayushman Bharat scheme which entitles each family earning below Rs 10,000 — and bereft of amenities like scooters and phone – a benefit of up to Rs 5 lakh. Health being a state subject, the AAP-led government in Delhi has the final say in what the people of the Capital city receive.

If we take into account the population of Delhi at approximately 2 crore, and the total expenditure of Rs 6,000 crore on health, the Delhi government would be spending about Rs 3,000 per person per year. At the same time, the Centre announced a budgetary allocation for the health sector for the 2019-20 fiscal at Rs 61,398 crore.

This gives the country’s population of about 133 crore an entitlement of Rs 461 per person.

Clearly, the central and Delhi government’s approaches to health are a study in contrast. It’s a question of priorities. While the government spends 1.3% of the GDP on health, the Delhi government allocates 13.8% of its total expenditure to health.

Delhi government hospitals give free treatment to everyone irrespective of income because of the belief in universal healthcare. Furthermore, Ayushman Bharat has empanelled over 6,800 private hospitals countrywide whereas Delhi government is banking on government-run hospitals to provide free healthcare.

Is it all political? Is the Delhi government reluctant to allow the Centre to take credit for improved health facilities in the Capital? Especially as, the name contains the word prime minister: Pradhan Mantri Jan Arogya Yojana (popularly called Ayushman Bharat).

Delhi Health Minister Satyendra Jain puts his government’s perspective across in an in-depth interview with Patriot. He speaks about why AAP’s health model is more rewarding and that Ayushman Bharat is a scheme which leans too heavily on the private sector, and is therefore not people friendly.

He explains why AAP wants to give priority to Delhi’s patients. Instead, the system has to bear the burden of patients sent from BJP-ruled neighbouring states, and persons who are Central scheme beneficiaries.

In an exclusive interview with Delhi’s Health Minister Satyendra Jain, he tells us about hospitals in the Capital inundated with outsiders, how the Centre takes credit for efforts the AAP-led government has made, and why the bhakts question freebies

How has the government improved state-run hospitals?

Firstly, in all Delhi government hospitals, we have made medicines free for everybody. We have also made all the tests free. In the country, the Delhi government hospitals are the only ones where there aren’t any cash counters, and the work is done without the cash counters.

If you look at Centre-run hospitals, even AIIMS, charges are levied for something or the other. But in our hospitals, we have made everything free for everyone — it is universal. Also, whatever hospitals are around, we are giving them world class renovation.

The hospitals with 100-200 beds are being converted to at least a 600-bed facility. The reason behind this is that in the smaller hospitals one cannot get all the facilities round the clock. If there is a 600-bed hospital, a patient can get all the services. And we also achieve economies of scale.

Say, you have a team of orthopaedic doctors for a 100-bed facility, and one would require the same number of doctors for the 600-bed facility. So, all the hospitals under the Delhi government are in various stages of development; some have tenders against them, some plans are awaiting sanctions, some have received EFC (Expenditure Finance Committee) approval, some are with the Cabinet, there are a few where work will begin immediately and three hospitals are  nearing the completion stage.

In Delhi, this must be the first time that all state hospitals will be world class, air-conditioned, and in fact, they will be better than private hospitals – at least it will not be any less than a private hospital.

The only difference will be that in none of these hospitals will private rooms be available. Either mantri or santri, whoever may go, the beds will be of the same level. Everyone will be treated, we will take the responsibility of giving treatment, but if someone wants a private room to watch TV then we are not giving that provision. So, we have kept our costing reasonable, and will give quality healt care service.

How much has the Delhi government spent on healthcare till now?

We spend over Rs 6,000 crore every year. For the residents of Delhi, tests are free of cost. Even for radiology tests like MRI, PET scan, CT scan, the patient can go to any Delhi government hospital’s OPD and get a referral from a doctor for the test in a private hospital. We have already done tests for 1.21 lakh people free of cost in the past two years.

If a doctor recommends an operation and it doesn’t get scheduled within a month, we get the patient referred to a private hospital and not a penny needs to be paid.

If someone meets with an accident on a road inside Delhi territory and you take the person to a private hospital, no matter what the cost is, the Delhi government pays for it. And the person who takes them to the hospital gets a reward of Rs 2,000.

The AAP-led government keeps saying that Ayushman Bharat is not feasible for Delhi…

Not just for Delhi, the Ayushman Bharat scheme is not feasible for the entire country. What the country needs is proper set-ups in government hospitals. Both Haryana and Uttar Pradesh are BJP-ruled states, where Ayushman Bharat is implemented. But go to a Delhi-government hospital and you will find 50-70% people from these states. When you ask them why do they come here, they say because there are no facilities available where they live.

Now tell me, do you want Ayushman Bharat or do you want proper treatment? They say they have given this scheme to the entire country, but in Delhi alone, more people have benefited from our free healthcare system.

What I think is that any scheme that is implemented should be universal, there should be no disparity, no exclusion. If someone wants to use the facility that the government is providing then how can you say no?

You say people from outside are coming and using the free facilities, is this something you want to stop?

Any health system takes into consideration the population of the area and the diseases prevalent. We are prepared to take care of 2 crore of the Delhi population. But if 10 crore come from neighbouring areas, how can it work? The entire system will fail.

The people of Delhi should get priority. Those who are paying taxes should get priority. Despite having all facilities, why should they end up standing in a queue for three hours to get medicines?

The counter to your statement could be that this is the Capital city and people believe in the healthcare provisions here, its doctors…

Then why are you asking me to bring in Ayushman Bharat? We are not saying no to anyone, we are giving treatment to everyone, right? I am giving treatment to those who are not my liability.

The Centre keeps advertising Ayushman Bharat, why don’t you open a hospital in Uttar Pradesh? Who is stopping you? I’ll give you an example of a government-run hospital in Noida’s Gautam Budh Nagar. Many emergency patients are brought from there to Delhi.

The hospital has set aside a huge van in which they fill 20 patients at a time and bring them to LNJP (Loknayak Jaiprakash Narayan Hospital). This hospital in UP has doctors, but they think, ‘Why do anything? Drop the patient off at (Chief Minister Arvind) Kejriwal’s hospital’.

I went to LNJP at 2 am once. I saw an ambulance with 18 patients inside, two of whom were dead. I was shocked, this was the scenario. The hospital staff say, “What can we do? If we don’t treat them, all will die”.

Instead of improving health facilities, the Centre is batting for insurance companies. Ultimately, there will be a very big fraud under the Ayushman Bharat scheme. What will this government do? They are bringing in insurance companies and will give them a low premium, after some time they will make it double, triple, even 10-times more.

When you are finishing off a government system and supporting only the private system then the government system will completely collapse and whatever premium the insurance companies demand, you will have to pay. When the American system has failed then why are you copying them? In America, the insurance billing is 2.5% of the GDP. Who got treated from that? Only billing is being done. And then you will see, eventually, billing taking place in government hospitals.

(Union Health Minister) Harsh Vardhanji is trying to push Ayushman Bharat. Okay, let’s say it’s a really good scheme. In Delhi’s population, there are just 10-12% who are eligible under their stipulated criteria — which means out of the 2 crore population, 10-15 lakh will be treated under it. And from that too, the data available to the Centre is from 2011.

Those who are ineligible include those who earn Rs 10,000 and more — whereas the minimum wage for Delhi is Rs 13,500. Also, those who have a telephone or a two-wheeler will be out.

In Delhi, there are 50 lakh families, and 50 lakh two-wheelers, 30 lakh cars, and 5-7 lakh commercial vehicles. Very few families don’t have a vehicle or a fridge. In our hospital, even if a crorepati comes, we don’t ask him to write a false letter claiming to be an EWS patient.

Thus, instead of bulldozing others, the Centre should look at the BJP-led states and implement the scheme properly so the people from those states are not compelled to come here.

I went to GTB hospital once. I asked a patient where he was from and he said Muzzafarnagar,(in UP). He had been shot. I was stunned that the policeman who brought him here did not trust a single hospital in the entire stretch from Muzaffarnagar to Delhi.

So I say, people should trust and have faith in at least the hospitals you have. In Delhi hospitals, when we came to power, the footfall in OPD was almost 3 crore every year. Now, the footfall is 6 crore. People will only come when they have faith.

Earlier, the OPD timings were for four hours, now I have made it 6 hours, converted those that weren’t daily into daily OPDs, made medicines free and made tests free. But the problem is also that the rise in footfall has impacted our system.

The Centre only keeps issuing advertisements — and then they will just fill up vans and send the patients here. A patient from Gujarat was being treated at LNJP hospital. He had been referred to the hospital for the operation. After that the man says, “Modiji has done my treatment”: this is called publicity.

You are getting your treatment done at Kejriwal’s hospital, you got a free surgery that would have otherwise cost Rs 5 lakh, but he didn’t do any advertisement for this.

The Centre pays for an operation of Rs 12,000 and then puts out 12 full page advertisements. But even the work we are doing, they are ready to take the credit for it.

What obstacles has the Centre put in front of the Delhi government, with regards to the health sector?

Currently, the MCD has stopped the functioning of 26 Mohalla Clinics, and three have been demolished. Have you ever heard in this country’s history that a government health centre has been demolished or stopped from being built?

So, these people are not scared of God. If God ever gets to know, then we will see the repercussions that they will have to face.

Anything other than the Mohalla clinics that the Centre has created roadblocks for?

See Mohalla clinics have got good publicity, so now they are so scared of the clinics being built. I for one have not understood what harm can come from Mohalla clinics? Let’s see what obstacles they bring up for the hospitals we are now getting made.

The middle class may be against their tax paying for the rich to be treated

No, this is wrong. The BJP has spread this conception that nothing should be free. This crosses the heights of beimani (dishonesty). First, you take all the tax and then say that nothing will be given for free. Why? Whose treasure are they getting into and spending so much money from? It’s the people’s money. And we are spending it on the people itself.

This is the only state where we don’t have a helicopter. We can stop the treatment of outstation patients and buy a helicopter. If you are levying tax, then basic facilities, like roads, parks, healthcare and quality education should be made free. Public transport should be subsidised. Or don’t levy taxes.

Electricity should be at an affordable rate; water should be free to a certain limit. These are all the things that we are doing. But they will just be against us, and also stealthily copy the same thing.

Then there are the well-educated, who get angry and ask: How can you give this for free? That you will make everyone a free loader. See, we are not giving anything for free. The public gave us money and we are spending it back on them.

Mostly politicians buy themselves a private jet. No one complains then. We say that forget private jet, instead of that, we want to give free healthcare, the reply is, “No no…we can afford it”.

Now tell me one thing, do you think that the man who rides on a Mercedes will come to our hospital? No, because the person next to him could be his building guard. So, let them exclude themselves. Why are you excluding them?

In government hospitals, earlier there used to be 15-20 private rooms, which would get all the care. These private rooms were a disease which we have eradicated.

We said we can give women air-conditioned travel on the Metro, but I can’t give private vehicles. But I am giving something better. A private car is for Rs 5-10 lakh but the ride I’m giving is a Rs 60 crore one.

Now see how much these bhakts are screaming about it, saying why have we done this only for women? Well, it is 50% of the population we are giving it to, so maybe the Centre should do the other 50%.

What would you say to the belief that AAP is against the Ayushman Bharat scheme because it is in opposition to the BJP?

There is no relation with our opposing the scheme and the BJP. If in Delhi you bring in a scheme which excludes 95% of the people, then what’s the logic? If you have to bring a scheme, it should be universal.

The world over, there is talk about universal, not exclusive healthcare.

Union Minister Harsh Vardhan called the Mohalla clinics ‘an utter flop’ and also said that ‘there was a drastic neglect of patient care in Delhi government hospitals.’ What do you have to say about this?

Sometimes I take bhakt’s calls. One said that there is no ventilator in these clinics. I tell them that  Mohalla clinics are not equipped with ventilators. Then they raise questions on how we can call it world class, if such facilities are not being provided.

Mohalla clinics do not have ventilators or operation theatres. They only have an MBBS qualified doctor — not specialists. You get the medicines the doctor prescribes, you can get 212 tests done at these clinics, and if the doctor thinks you need an ultrasound or an x-ray, he/she then recommends you get it done outside.

I agree we don’t have 400 facilities. These are clinics and not hospitals that should have full-fledged services. Doctor sahib (Harsh Vardhan) should know, he has run a clinic for many years. If in all his years, he has run a better clinic than our Mohalla clinics, then let us know.

The doctor to patient ratio is still less in Delhi…

Compared to the entire country, the doctor-patient ratio is much better here. There’s about one doctor for 3,000 patients. The thing is, perhaps we aren’t using them quite well. We don’t have any problem of insufficient number of doctors.

But we always had a problem of brain drain so how are you keeping them here?

No, they are not leaving Delhi, they are coming here. Firstly, I don’t put any conditions on them. I say come work for six hours and after that do whatever they want. They are free birds. I pay them per patient. And they are respected.

We will open 1,000 Mohalla clinics and we will get 5,000 doctors.

From Delhi or outside?

I didn’t say that we wouldn’t take doctors from outside of Delhi. Anyone can come.