Tug of war

The Delhi government is adamant on not implementing centre’s Ayushman Bharat scheme. But is this political quagmire going to deprive patients of benefits? is Delhi’s healthcare setup efficient enough to provide the same assistance?

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), a scheme touted as the world’s largest government-funded healthcare programme — has not yet been implemented in the capital. Several reasons, ranging from its name to its inefficacy and its lack of inclusiveness, have been given by the AAP government for evading the scheme. But is the reasoning justified or is this a political tug-of-war?

The scheme provides annual health cover of Rs 5 lakh per family to 107.4 million poor and vulnerable families listed in the socio-economic caste census data for secondary and tertiary care hospitalisation through a network of empanelled hospitals. A little under 7,00,000 people have so far been treated free in various empanelled hospitals across India under this scheme, which was launched on September 23. But this ambitious project has been in a mire in Delhi as the AAP government is at loggerheads with the central government.

Even though Delhi has not adopted the scheme, nine private hospitals have signed a Memorandum of Understanding to provide their services under the AB-PMJAY. With the Delhi government and the Centre failing to arrive at an agreement on the scheme, the National Health Agency (NHA) is pushing hard to get at least private hospitals in the city on board. A few prominent ones such as Sir Ganga Ram Hospital have agreed verbally to be a part of the scheme, officials said. But the tussle has resulted in major government hospitals such as Lok Nayak Jai Prakash (LNJP), Guru Teg Bahadur (GTB) and GB Pant, which see a huge rush of patients, being left out of the scheme.

“We came to Delhi with the hope of getting good treatment, but we got to know that the hospitals here are not empanelled to provide free treatment under the AB-PMJAY scheme. We are from a small village near Delhi, so we thought coming here would be the easiest way to get affordable, yet good healthcare services. But there is a lot of confusion here,” says Gyan Kumar, whose mother is admitted in GB Pant Hospital.

Cygnus Sonia Hospital in Nangloi, which according to reports has been empanelled, has several clueless patients. “There are some hospitals in Delhi that I think have recently been enrolled in the scheme, but many are still not a part of it. This has created a lot of confusion. Also, we heard that this hospital has been empanelled, but the services are not yet being provided,” says Jitendra Gupta, whose wife underwent a major operation in the hospital.

On the occasion of the scheme’s completion of 100 days, Finance Minister Arun Jaitley took to social media to highlight the achievements of the programme. “In the first 100 days, 6.85 lakh patients have been provided hospital treatment. 5.1 lakh have availed of the scheme for which payment has been released. This averages 5,000 claims per day for the first 100 days. No patient has had to pay a single rupee,” he tweeted.

“Many people from the weaker sections avoided hospital treatment in order to avoid the burden of an unbearable payment. Today 40% of India’s poorest are assured of treatment in a hospital at the cost of the exchequer. Health sector jobs are set to increase. PMJAY will help create an accountable health system because beneficiary feedback is an integral part of its implementation,” he said.

The central government has been pushing for the scheme and has stated several benefits accrued from it within the 100 days of its operation. “The outcome has been better than what we expected, even in greenfield states that have had no health insurance schemes running in the past. In UP, the number of admissions increased by more than 60% during the past one month — that shows the rate of pick-up is remarkable,” says Indu Bhushan, chief executive officer of Ayushman Bharat. Despite this, the AAP government has been apprehensive of the scheme.

Nomenclature has also been a bone of contention. AAP wants the scheme to be called Mukhya Mantri Aam Aadmi Swasthya Bima Yojana Ayushman Bharat, but the Centre wants Ayushman Bharat in the name first. Chief Minister Arvind Kejriwal has claimed the scheme is a public relations exercise that will prove to be another jumla and is just another “white elephant in the making”. AAP alleges that it covers only six lakh out of 50 lakh families in Delhi, further claiming that the Delhi model of healthcare is better.

“The state government does not agree with the Centre’s health insurance scheme because it is bound to exclude a majority of Delhi’s population who need it. The Delhi government will work towards implementing its own health insurance scheme,” Dr Kirti Bhushan, director general of health services, had said while opting out of the scheme.

“Under NHPS, the government will cover beneficiaries according to the socio-economic caste census of 2011. The population of Delhi is rapidly growing and greatly varies from what it was in 2011. So, providing insurance on the basis of that data will be a flawed practice,” he added. The party said that it recognises the need for a universal healthcare but added that Ayushman Bharat was bound to fail.

“The Ayushman Bharat scheme, designed by the Modi government, caters only to secondary and tertiary requirements. It gives a miss to the most important: primary healthcare. AAP is of the belief that the Modi government should have learnt from the successful Delhi model of healthcare and should have incorporated those in the scheme. Delhi government provides all medicines, tests, operations and other healthcare requirements for free to all patients; it doesn’t cater only to those admitted,” the party said in a statement.

Many patients standing in a long queue at Aruna Asaf Ali government hospital say that they get free medicines and tests there. But outstation patients at GTB hospital seem troubled as the hospital is neither empanelled for the AB-PMJAY scheme nor does it offer free services to outstation patients. “Since we are outstation patients, we cannot avail the benefits provided by the Delhi government. We heard the AB-PMJAY has also not been implemented here, so we have no financial assistance,” says Gagandeep Kaur, a patient who has come from a small village in Punjab.

For now, four major hospitals in the city — AIIMS, Ram Manohar Lohia, Safdarjung, and Lady Hardinge Medical College — are on board for the scheme. Three private hospitals — Cygnus Sonia Hospital, Dr Shroff’s Charity Eye Hospital and Cygnus MLS Super Specialty Hospital — have been empanelled. Lifeline Hospital, Kalra Hospital, and Akash Healthcare are in the process of being empanelled.