Ayushman Bharat: a critical perspective
Mains Paper 2: Health
Prelims level: National healthcare schemes
Mains level: Services relating to Health
The Ayushman Bharat: National Health Protection Scheme
(AB-NHPS) has a defined benefit cover of ₹5 lakh per family per year
covering over 10 crore families.
The ideation of the scheme needs to be lauded for
addressing one of the primary issues of our healthcare system.
The rising out-of-pocket expenditure. In 2011-12, more
than 55 million Indians were pushed into poverty because of rising expenditure
Several studies have shown that an increase in illness and
consequent expenditure on drugs, diagnostics and care leads to the exacerbation
of poverty in developing countries.
Government data suggests that about 63% of the people have
to pay for their own healthcare and hospitalization expenses as they aren’t
covered under any health protection scheme.
There is no doubt that the scheme is well-intentioned.
Its implementation in the current form could create an
incentive problem in certain states, which could potentially reduce their health
Why it is considered as a critical?
Under the 7th schedule of the Indian Constitution,
health is a state subject.
This means that health as a motif, gains electoral
importance primarily at the state level.
The reason for this is simple.
Apart from central institutions such as the All India
Institute of Medical Sciences, a major chunk of the hospitals/ medical centres
is state-owned and -operated. Therefore, the accountability of these also falls
with the state.
A nationwide scheme of health insurance to supply
healthcare facilities at the state level leads to a dilution of the state
responsibility in the provisioning of the same.
The states’ participation in the scheme mandates them to
contribute funds for insurance, which naturally diverts funds allocated to
building healthcare infrastructure within the state.
Portability of healthcare allows the beneficiaries to
avail cashless benefits at any empanelled hospital across the country.
This move, while increasing access, is also expected to
cause pooling of patients in hospitals, where the health infrastructure is
relatively well developed.
Analysing the data
Access to health services varies significantly across
India only has 0.62 doctors for every 1,000 population, as
opposed to the World Health Organization standard of 1 doctor per 1,000
At the state level, Karnataka, Tamil Nadu, Kerala, Punjab,
Goa, and Delhi have more than 1 doctor for every 1,000 people.
In Tamil Nadu and Delhi have 1 doctor for every 253 and
334 persons respectively.
Such a high density of doctors in these states puts them
at par with countries such as Norway and Sweden in terms of access to
In comparison, Jharkhand, Haryana and Chhattisgarh have
only 1 doctor for every 6,000 persons, which greatly reduces the accessibility
of healthcare in these states.
Improving the infrastructure
The existing health infrastructure created by these
states is an output of years of heightened health spending and investment in
The high correlation between health spending and health
performance has strong theoretical and empirical roots.
According to a 2018 report by NITI Aayog which formulated
an index of health, the 3 top-ranking states were Kerala, Punjab and Tamil Nadu.
These were also the 3 top spenders on health
infrastructure from 2004-05 to 2015-16.
In fact, equalization of health expenditure across states
is desirable for achievement of sustained national health targets.
Over the years, the disparity in per capita health
expenditure across states has exhibited an increasing trend.
The average per-capita health expenditure of the bottom
three states was ₹122 in 2004-05, ₹130 less than the average per-capita
expenditure of the top spenders.
This gap has grown substantially in the last 10 years to
reach ₹561 in 2014-15.
These scenarios could create a disincentive for the
poorer states by reducing their responsibility towards investing in health
They may become comfortable in disbursing fewer resources
towards actual infrastructure development, and rely increasingly on the private
sector as well as other states for providing healthcare facilities to their
This would cause a diversion of resources from preventive
measures of disease management which are the backbone of public health, towards
curative measures which would not be efficient in the long run.
The high level of positive externalities and the huge
costs of preventive healthcare can only be borne by a Centre—state collusion.
Q.1) Which of the following statement is true about "Ayushman Bharat -
National Health Protection Mission", recently in news ?
A. A beneficiary, covered under the scheme can take cashless benefits from any
public and empanelled private hospital across the country.
B. Pre and post Hospitalization expenses and transport allowance per
hospitalization is also covered under the scheme.
C. Both 1 and 2
D. Neither 1 nor 2
Q.1) National healthcare schemes often dilute the responsibility of the states
and overlook the need for preventive measures. Critically analyse the statement.
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