India's public healthcare system is sick. Modi govt’s Ayushman Bharat the “world’s biggest healthcare programme” looks good on paper but there are many factors which make its implementation uncertain.

India's public healthcare system is sick. In late September, Prime Minister Narendra Modi's administration launched Ayushman Bharat, meaning Long Life India, to address this illness.

This initiative, which has been described as the "world's biggest healthcare programme" will ensure more than 500 million Indian citizens who currently have no coverage. Will "Medicare", as the programme has been labeled, cure what ails India's public health care system?

The answer is maybe. That answer must be equivocal because of the enormity of India's healthcare needs, concerns regarding the adequacy of funding to address those needs, and uncertainty regarding Medicare's implementation.

Ayushman Bharat

Healthcare in India today is the tale of two groups. The first group is the wealthy and upper-middle-class who receive their healthcare primarily from private sector providers. Overall, that healthcare is of good quality and easily accessible but can be expensive.

The second group is the lower middle-class and the poor who receive their healthcare primarily from public sector providers. Overall, that healthcare is of poor quality, difficult to access and the money spent on it is insubstantial.

Public healthcare

In 2015, India's public expenditure on public healthcare was approximately one %of its GDP. This compares quite unfavourably to other countries who provide some form of universal healthcare coverage. For example, Singapore expended 2.2 %of its GDP, South Korea expended 4.2 %, and the United States consumed 8.5%.

India's small expenditures are reflected in its healthcare performance. Some of the deficiencies of the current system are.The per capita insurance expenditure on healthcare is one of the lowest in the world. Over 75 % of Indians have no health insurance.

The new scheme looks good on paper. But establishing 150,000 health and wellness centers is much easier said than done.Though the states carry the primary burden for healthcare coverage, there is a significant difference in the scope and nature of that coverage across the country.

There is a substantial rural-urban disparity regarding the quantity and quality of coverage.Compared to the rest of the world, India has an average number of doctors, but they attend to only one-third of the Indian population.The lack of adequate insurance coverage and availability of public sector health care causes Indians to have to cover more than 60% of their expenses personally.

Ayushman Bharat is structured to address these conditions. It provides low-income families insurance of up to $6,950 (nearly 500,000) for hospitalization, calls for the establishment of 150,000 health and wellness centers to provide primary care throughout India and emphasizes holistic healthcare ideas such as yoga as part of this intervention.

This appears to be a robust framework for launching this new initiative. The government has appropriated $1.5 billion for Medicare health insurance for 2018-19 and 2019-20. Of this, $300 million is allocated for the first year of the programme.