Public health experts, including doctors from the AIIMS, on March 20 questioned the potential of government's flagship healthcare scheme, Ayushman Bharat, claiming it was an "official channel" through which public money will go to the private sector.



Referring to implementation of such healthcare schemes in the past, sector experts pressed for urgent need to strengthen publicly funded hospitals to offer universal health care, while speaking at a panel discussion on 'Ayushman Bharat: Fact and Fiction', organised by AIIMS Front for Social Consciousness in the campus of country's premiere medical institution here.

The Ayushman Bharat scheme was nothing but an old wine in a new bottle, said Dr Vikas Bajpai, professor at the Centre for Social Medicine and Community Health of Jawaharlal Nehru University. He stressed on the need to analyse the "failures" of the various publicly-funded health insurance schemes, including the Rashtriya Swasthya Bima Yojana or RSBY, to ensure that "inadequacies" in their implementation were not repeated.

"Apart from lack of desire to commit the required financial resources, the scheme is oblivious and irrespective of the real causes of ill-health of the people, especially the poor," he said. "This was the creation of just another official channel through which public money will go to private set-ups," Dr Bajpai added.

Subrato Sinha, head of department of Biochemistry at AIIMS, said Ayushman Bharat does not provide out-patient department care support, which is a major component of health expenditures and is as expensive as the in-patient care. "Also, the main thrust of any healthcare programme should always be on improving and strengthening the public health infrastructure as insurance is always less efficient than direct provision of health services by the government," he said.

Dr Pratap Sharan, professor in the department of Psychiatry at AIIMS, said the government is shifting its stance from providing services to purchasing services mostly from the private sector and "it is an abdication of its basic responsibility."  Dr Shah Alam Khan, professor in the department of Orthopaedics at AIIMS, referring to a recent report released by the WHO, which showed that the out-of-pocket expenditure on health in two countries -- India and Pakistan -- was the maximum, said, "This means people were spending more money in these two nations, which almost went to war after the Pulwama attack. This shows that both the countries do not care about what is happening to the health of their people." 

He pointed out the hurdles people face to avail the benefits once they enrol into the scheme and stressed on the need for identification of those hindrances. "The crux of the problem is in the very first Budget presented by the current government in May 2014, they slashed the budget for health by 20 per cent. The only way you can help the poor and the needy is by increasing by spending on healthcare in public hospitals and that is not happening," Dr Khan said.

Former chief of AIIMS Resident Doctors' Association, Harjit Bhatti, said budget allocations "do not reflect the government's good intentions" because Rs 6,400 crore for 10 crore families comes down to Rs 640 per family and Rs 128 per person, which was "too low" to expect good treatment from hospitals.

"The Ayushman Bharat is an eyewash to hide the incompetence of the government which is not able to provide required healthcare infrastructure effectively," he said.

Imrana Qadeer, faculty at Council for Social Development, said in western countries, where national insurance was successful in providing basic health services, its universality and strong regulatory mechanisms of the state that controlled the private sector were critical.

"Neglect of basic healthcare infrastructures under the National Rural Health Mission by drastically curtailing investments, increases the load on secondary and tertiary care institutions and rationalises partnerships with private sector, which are waiting to enhance its profits through schemes like RSBY and PMJAY," she said.