Ayushman Bharat – PM flags off the ambitious Modicare

Prime Minister Narendra Modi on Sunday launched the world's largest public-funded medical insurance scheme under which a cover of Rs 5 lakh would be provided to 10.74 crore families from the poor and deprived section of the society.

“The Pradhan Mantri Jan Arogya Yojana-Ayushman Bharat is a game-changer initiative to serve the poor. It is the world's biggest health assurance scheme and the number of beneficiaries is roughly equal to the population of the European Union, or the population of America, Canada and Mexico, taken together,” Modi said, launching the scheme in Ranchi.

Soon after the roll out, the first five patients were admitted in Rajendra Institute of Medical Science for urology and cystoscopy procedures. More than 13,000 hospitals joined the scheme so far and applications from another 2500 plus hospitals are pending.

The scheme would provide cashless health benefits for 1,350 procedures for which rates have been fixed by the government, much to the chagrin of a section of private hospitals that are yet to join the scheme. Pre and post-hospitalisation cost, diagnosis, medicine and transport costs are covered in the package.

As many as 31 states and Union Territories are currently on-board for the mega health insurance programme. Kerala, Telangana, Odisha and Punjab are yet to join the scheme. States that have their own health insurance schemes for the poor will merge their existing programmes with the central scheme.

The scheme offers a migration option too. “For States that are a part of PMJAY, people can get the benefit of the scheme in whichever of these States they go to,” Modi said. The ambitious healthcare scheme, dubbed as Modicare, was launched two days ahead of its original target launch date of September 25 – the birth anniversary of BJP ideologue Deen Dayal Upadhaya.

PMJAY targets the poor, deprived rural families and identified the occupational category of urban workers’ families as per the latest Socio-Economic Caste Census data for both rural and urban areas as well as the active families under the Rashtriya Swasthya Bima Yojana.

The 71st round of National Sample Survey Organization found 85.9% of rural households and 82% of urban households have no access to healthcare assurance. More than 17% of the Indian population spend at least 10% of household budgets for health services.

Catastrophic healthcare-related expenditure pushes families into debt, with more than 24% of households in rural India and 18% population in the urban area meeting their healthcare expenses through some sort of borrowings.

While the PMJAY aims to reduce out of pocket expenditure on health, there are still several bottlenecks that the government needs to overcome to make it a success.

Private hospitals are in disagreement on the package rates, training of the healthcare staff is inadequate and the standard treatment protocols that are to be the cornerstone of the scheme are nowhere in the sight.