World’s Largest Government Funding Scheme: Ayushman Bharat Scheme

As the Ayushman Bharat scheme, fulfilling all the dream of a healthy India. Which is the world’s largest government funding scheme; and is targeting more than 50 crore poorest beneficiaries or nearly 10 crore households and each family would have a cover of Rs 5 lakh per year. The Socio-Economic Caste Census of 2011 is the basis of beneficiary identification under the scheme; and it is extending to those families that were availing of the government’s earlier scheme; i.e. the Rashtriya Swasthya Bima Yojana.

Ayushman Bharat would provide secondary and tertiary healthcare hospitalisation to the beneficiaries across 23 specialities through 1,390 packages, which include treatment/procedures such as cancer surgery, radiation therapy, chemotherapy, cardiac surgery, stents, neurosurgery, spine surgery and specialised tests such as MRI and CT scan, among others, with the flexibility to include more that are not specified as of now.

Government funding scheme

About 16,000 hospitals, of which a little over 50% are private hospitals, have been empanelled so far. It is hoping that about 1 crore poor would be benefiting each year (6.85 lakh people got free treatment in the first 100 days of the roll-out of the scheme); as the scheme gathers momentum with increasing awareness about the mission. Here, it may also be mentioned that new hospitals would be opened in tier 2 and tier 3 cities; creating new jobs as a result of the scheme.

The scheme covers only hospitalisation and not outpatient care; which is to be borne out-of-pocket, but the poor; for whom the scheme is meant, can not afford this. Our statistics show that in India, on average, only about 4% of the total population gets hospitalising and the rest 96% get treated; with free services as outpatients; usually near their homes like the Mohalla Clinics of Delhi. Thus, integrating primary healthcare with secondary and tertiary healthcare under AB-NHPM is necessary.

National health agency

Besides the above, the scheme, within 10 months of its implementation; is encountering a big problem as fraudulent practices like fudging of beneficiary data have been noticed; by the anti-fraud unit of the National Health Agency (NHA) the nodal agency for the scheme. In addition, as far as the case of the fake beneficiary cards being issuing by the Common Service Centres (CSCs) is concerning; it is saying that there are other types of frauds committing by hospitals.

Although the above mentioned anti-fraud unit has a fraud detection module; with the provision of 94 types of automatic checks in the digital system; that would set off alarms if it detects aberrant; and unmatching data, hospitals have not desisted from committing such frauds. If they were not aware of such inbuilt checks in the system; the de-empanelling of 250 hospitals would have been a good lesson for all erring hospitals.