In a country like India considerable amount of the population lives in minimalist conditions with paltry or no earnings, thus, living below the poverty line. In such a dismal situation, the health risks pertaining to these groups are far higher than others. Thus, it behoves on government the onus to identify these sections of society and significantly include them in their policy formulation. Especially at this debilitating covid pandemic, these low-income groups further become vulnerable and are pushed to the margin. Therefore special attention towards them takes precedence.
The PMJAY: Ayushman Bharat scheme rolled out by the BJP government in 2018 is a case of targeted policies towards the subaltern population. PMJAY is an entitlement-based scheme covering vulnerable families based on deprivation and occupational criteria as per SECC (Socio-Economic Caste Census) data. These groups are entitled to a government health insurance policy of rupees 5 lacs per family per year, covering secondary and tertiary treatment. It offers cashless and paperless access to beneficiary services at the point of service in any public or private empanelled hospitals across India. This ensures affordability and easy access ability to avail these healthcare services. The PMJAY entails a comprehensive healthcare model for the poorer sections and has significantly benefited them during the covid-19 outbreak. It covered the cost of treatment and medicines of a patient who is a beneficiary under the Ayushman Bharat scheme. Though there is a state-wise disparity in performance, many states have performed commendably, covering a proportionally greater number of people. In contrast, in some states, the coverage rate is low or nil.
Why does this analysis show?
While PMJAY is a Central Government health care policy, health being a state subject establishes the state’s role in rolling out any health care service to its people. Thus, it is essential to implement such welfare schemes to confidence the state government and provide them with adequate resources and training required to pan out the scheme successfully.
Though Ayushman Bharat is a well-formulated scheme, it still needs to fill up various policy gaps; albeit it is an example of good governance, it needs to adopt a holistic approach towards health care. The first step towards effective healthcare is preventive healthcare. Therefore, any health-related policy needs to address this part of healthcare, especially when it has a larger area of jurisdiction. PMJAY scheme significantly reallocates government healthcare funds away from investment towards funding for the medication cost of the lower rung of the society. Thus, in States where the healthcare infrastructure is already low, implementing such a health care scheme will further take a heavy toll on investment. What this delineates is that there is a cash flow from bottom to top, which means that economically weaker States fund the health care of their population to avail services in the states with pre-existing healthcare facilities. This adds to the health revenue of those States, further adding on to more investment in infrastructure, subsequently increasing state economic disparity.
Also, the scheme covers only those belonging to the lower strata with certain identity proof and leaves the population with no government given identity, living in temporary settlements due to their forced conditions.
Therefore any good policy formulation requires that every member of the society is recognised as a significant beneficiary. The government needs to take regular surveys and create a proper database to roll out such policies successfully. Good governance means taking up timely action whose results are outcome-driven. Hence for further increasing the effectiveness of the PMJAY: Ayushman Bharat scheme, these loopholes need to be addressed and a broader policy viewpoint adopted.
(Tanvi Singal is interning with CPRG and student of St. Stephen’s College)