Ayushman Bhava – A Programme of verbosity


Mr. Modi announced reportedly the world’s largest health care scheme by any Govt. on the Independence Day and launched the schemeformally  on birth day of RSS founder  Deendayal. PM Jan Arogya Yojana ( PM – JAY , another self-obsessive acronym) i.e. September 25. The highlights of the scheme are like – Rs. 5 lakh medical insurance for each family covering 10 cr families as per National Socio-Economic Caste census ( SECC), of which, about 80% families are from rural areas and 20% are from Urban areas with an initial outlay of Rs. 5000 crore and Rs. 10000 going forward. He proposes to fund it jointly with State Governments and levy 1% cess on taxes additionally like education cess like he general practice of levying these cesses every time a humanitarian scheme is introduced.

We are scoring our GDP at about Rs. 125 lakh crore and spending nearly approx. Rs. 5 – 5.5 lakh croretowards healthcare, of which nearly Rs. 2.25 – 2.5 lakh crore is generated out of medical insurance . The industry estimates are that approx. 70% of spending goes into hospitals and balance to pharma, medical equipment etc. Before we go into seeing the kindness of this scheme, we need to understand that only top 20 cities in India have access to healthcare infrastructure, especially in secondary and tertiary health care, and is not even percolating to Tier III and IV towns. We still have 2/3rd of population living in rural areas only.  At least, a third of our population does not have access to primary health care. We have less than 9 doctors per 10,000 population which is way below general standards of health care of any decent economy.


Firstly, Modi boasted of himself that this idea has never occurred to Congress in the past 60 years,  whereas this idea occurred to him during the election year after passing 4 years of his tenor in the Honourable PM seat. This scheme is based on SECC,which  has never been conducted on scientific basis and does not even reckon “caste” except a broad census of SC/ST though it terms it as “ caste census” too. This scheme is supposed to cater to people like rag pickers, beggars, casual labours in urban area and agricultural labour in rural areas who are most vulnerable sections of society.

Aadhar cards have been issued to 90% of the population only so far, cutting down the access to the targeted population by straight one fourth of the eligible people. Another criterion is that people should have a bank account ( which was essentially driven by Jan Dhan Yojana) and there are still nearly 15 crore adults who do not have bank accounts. This talks volumes about our informal economy. Though BJP Govt says the scheme is going to reach 10 cr.families, the actual estimated size of reach for this scheme could be around 6-6.5 cr families of the targeted population.Further, the scheme restricts the eligibility to those families where there is no adult member present between 16-59 years of age and this takes the entire scheme down to the ground assuming that ‘ a man or woman can earn freely to support their own healthcare and that of family tooin the society as long as they have strength in their muscles‘ which is no way the case. This drastically constricts the genuine socially and economically backward sections to avail the benefits. An industry survey report points out that 30% of Indian rural population do not even consider accessing hospitals, due to the fear of expenses but not because they have no virile adult in their families.It is further yet to be seen what kind of barriers in terms of  processing of a health care requests are going to pop up, as usually, considering involvement of biometric authentication and other verification processes coupled with bureaucratic processes  for indigent and impoversihed  people who do not have a strong and literate adult support in the entire family.

First comic fact about this scheme is to boast it as “world’s largest health care scheme “ and what the Prime Minister of India needs to remember is that, India, by virtue of its wide geography and large population scores many  “ largests” or one of the largests in the world to its kitty like rail network, transmission network,  gold consumption, producer of steel etc. What makes sensible in claiming “ largest “ tag is always benchmarked by “ per capita “ and this does not take India’s per capita health care access to people as “ highest “ in the world not even anywhere close to the highest in the world.


Only one third of total doctors in India present in rural areas whereas 2/3rds of population lives in rural areas. It is a disconsolate fact that rural India accounts for 70% communicable diseases and the access to healthcare infrastructure is utterly poor. The Govt. hospitals have large presence in rural areas though with below par adequacy, which is nearly 6 times below what is available in urban areas. These hospitals are general hospitals with no emphasis on secondary and tertiary care. While the rural India marks significantly low in terms of availability of healthcare infrastructure, the Government expects these vulnerable sections to travel to a closest city/urban for their in-patient treatment incurring huge travel, stay and living expenses for the patient and family attendants. Of estimated 3 crCoronory Artery Disease patients in India, 1.6 crore nos. originate from rural areas and they need to reach urban/city areas to access the specialized surgeries to be done on the patients. Such patients need atleast 15 days of stay in hospital with a minimum of 5 days stay in ICU and regular visits of check up for next 3-6 months, atleast. Besides, such patients need to access these hospitals prior to hospitalization for diagnosis and others which are not covered under this scheme. As an example, if someone has Coronary Artery Disease  and is supposed to incur about 3 lakh on the surgery and other medical procedures post-hospitalisation, a patient needs to incur atleast 25% of it towards pre-hospitalisation expenses and regular check ups as well in terms of living and incidental expenses. And, the Prime Minister talks pompous about reaching most vulnerable sections like rag pickers, construction workers, sewage workers etc. who cannot even think of taking such burden of travelling, taking a shelter for pre-hospitalization and post-hospitalisation, accessing to a high end health care institutions and incurring such huge expenses. This is a major deterrent in reaping any benefit of the scheme. Instead, the Government could have made health care facilities accessible in rural areas which not only involves an economic activity in rural areas but brings the spirit of the scheme to life.


This scheme largely benefits those private hospitals which are specialized in secondary and tertiary health care and located in city and metro areas as even the rural population is expected to stretch to reach these specialized hospitals. This Rs. 10,000 crore is directly accruing to the bottom line of major players like Apollo, Fortis etc. These healthcare companies are building up additional capacities to cater to PM-JAY. While this is so, as the Government hospitals, except premier institutions like AIIMS, NIMS etc. , will keep catering to less dreadful and routine illnesses of hospitalisation like diarrhea etc that too in urban and city areas.


Another major impending infliction the country would experience is the escalation in healthcare prices all over. The medicines and the hospitalisation expenses are expected to soar like west as the Government , on one side, encourages private enterprises in health care sector and, on the other side, it provides insurance too. The % to GDP towards health care expenditure may go up with a factor of artificial escalation in prices and this piece of growth, to that extent, has no additional value and unproductive too. If an MRI or CT Scan is conducted on the patient of viral fever, it does not increase life length of the patient nor get the patient cured much faster.

The burden of Rs. 10,000 cr is actually not much to the Government as it is no bearing the burden alone but also 40% is shared by the State Governments too and an additional tax is expected to be levied for the same while the aggregate budgets of state and central Governments is around Rs. 60 lakh a year. The accessibility of this scheme to the destitute and most vulnerable sections of society seems over pompous considering various tangible and intangible filters in terms of rural urban divide, eligibility conditions, poor public health infrastructure etc. The goal is missing as we are not building rural healthcare infrastructure and  we are not making the industry rural friendly or poor-people friendly. The need of the hour is to strengthen the Public health care system and we are yet to see such large spending like Golden Quadrilateral and NSEW Corridor projects in Roads happening in hospitals too. The chain of hospitals , minimum possibly , in inevitable PPP mode, coupled with a kind of grant from Government would make such vision possible and ignite much of economic activity too. However, it would surely impair the growth of private enterprises in the field restricting future access to the markets. This actually strengthens the access of health care to public in much more convenient way and the benefits of the revenue will also accrue to the Government on routing these scheme transactions. The importance of human capital and long term nurturing of healthy life to all will take this country long way to progress in terms of building strong economicfundamental too, which is the missing point in entire episode of our Government’s so-calledvision. We have a Prime Minister who changed nomenclature of “ Medicare “ as “Modicare” to work towards that desired goal and unfortunately that does not work !

P Victor Vijay Kumar  is anfinance &investment banking professional. He can be reached at [email protected] or facebook ID “ P V Vijay Kumar” )

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