Can Ayushman Bharat National Health Protection Mission protect health of India’s Poor?

The recently introduced Ayushman Bharat National Health Protection Mission has been projected as a big public intervention in the health sector for protecting the health of India’s poor and vulnerable. The health insurance scheme under Ayushman Bharat promises to offer coverage of 5 lakh rupees for meeting hospitalisation or inpatient care expenses for a total of 10.74 crore households in the country with no cap on age or number of household members. Our analysis of the secondary literature and available latest all India level data from National Sample Survey Office raises a number of questions regarding the viability and effectiveness of the scheme. First, the budget allocated for this scheme is grossly inadequate given the large coverage of the scheme in terms of number of households and sum assured.

Second, the experience of the previous Rashtriya Swasthya Bima Yojana (RSBY – another government initiated insurance scheme for the poor introduced in 2008) is not very encouraging both in terms of the percentage of targeted households covered and the rate of reimbursement. The states with higher incidence of poverty were found to have lower proportion of its population under the government supported insurance coverage and vice versa. Moreover, the low reimbursement of expenditure coupled with higher utilisation of private facilities led to selling of assets and borrowing for many poor households with government provided insurance. Third, a significant limitation of Ayushman Bharat as well as the previous RSBY is that they do not offer any coverage for outpatient care. The cumulative annual value of expenses on outpatient care can be high for households with elderly and chronically ill members and may go beyond the capacity to pay for the poor and vulnerable households. Finally, the experience of countries like United States of America, China, Thailand and Mexico suggests that solely relying on the insurance route for providing universal health coverage may not be enough unless complemented by other public interventions on health infrastructure, manpower and preventive care. Neither the policy document on Ayushman Bharat nor the central budget allocated for it gives any clear impression that the government is serious about the scheme as it does not address the issue of supply side inadequacy and presence of a credible regulatory mechanism to deal with the private health care providers. One may reasonably doubt if a new intervention which blows up the scale of a previously unsuccessful or partially successful intervention without addressing its limitations can achieve any meaningful purpose. This forces us to argue that instead of spending crores of rupees on insurance schemes for the poor, the government may directly invest in the health sector, thereby increase the supply of publicly provided health care of acceptable quality at an affordable cost for the poor population.

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Subhanil Chowdhury is Assistant Professor at Institute of Development Studies Kolkata. Email: subhanil@idsk.edu.in

Subrata Mukherjee is Associate Professor, Institute of Development Studies Kolkata. Email: subrata@idsk.edu.in