As 2019 dawns, all eyes will be on the Lok Sabha elections and whether the BJP, having suffered setbacks in a recent string of Assembly elections, can come close to its massive 2014 mandate. For the Indian health sector too, 2019, will be an epoch-making year. It will give an indication whether, as the BJP-led government seems to be hoping, health programmes can really win elections or whether they are the political black hole that parties have often suspected.
Simply put, 2019 will be the year of Pradhan Mantri Jan Arogya Yojana (PMJAY), the year that will make or break the flagship programme that already has the international health community excited and talking.
The question whether health programmes can win elections is an old one. In 2005, when the then UPA government launched the National Rural Health Mission it won acclaim nationally and internationally. But when UPA 2 came to power in 2009, that win was attributed not to the programme that brought healthcare to villages but to the Mahatma Gandhi National Rural Employment Guarantee Scheme.
That is why, as the government goes all out on PMJAY, a tertiary care scheme launched by Prime Minister Narendra Modi on September 23 that gives an annual health cover of Rs 5 lakh to 10.74 crore families, with the Prime Minister personally monitoring the scheme, the election may hold the answer to the decades-old question.
For Y S Rajashekhara Reddy, former Andhra Pradesh Chief Minister, the tertiary care scheme Arogyashri is already credited with powering his 2009 win. The answer to whether a health scheme could work the same magic in a bitterly fought Lok Sabha election, where Opposition parties are working on a maha gathbandhan, could shape the way ahead for the long-pending demand of increasing health spend to 2.5% of GDP.
That the government is banking heavily on PMJAY is evident from the fact that while hoardings and publicity material for the tertiary care programme are everywhere, along with photos of the Prime Minister, the other arm of Ayushman Bharat — setting up of 1,53,000 health and wellness centres, which many health experts feels is the real pathbreaking decision, has been not as prominent in the public eye. Health Ministry sources say about 4,000 have so far been set up.
Health and wellness centres will provide comprehensive maternal healthcare services at sites equipped to service as “delivery point”, neonatal and infant health care services, childhood and adolescent health care, contraceptive services, reproductive healthcare, management of communicable diseases, screening and comprehensive management of noncommunicable diseases, basic ophthalmic care services, basic ENT care, screening and basic management of mental health ailments, basic dental health and geriatric health care.
Of the two arms of the flagship health programme, only one seems to be hogging most of the limelight with daily reviews in the Prime Minister’s Office (PMO) and daily status updates from its implementing agency. Ever since its official launch on September 23, every evening at 5 pm a report goes to the PMO from the National Health Agency (NHA) about the number of cards issued, the number of beneficiaries admitted, claims raised down to the number of calls answered and letters dispatched to beneficiaries. The newly formed NHA is the implementing authority for PMJAY.
Till December 29, 38.81 lakh e-cards had been generated under PMJAY, with 10,904 hospital admissions across the country bringing the total to more than 6.73 lakh since the launch. The average claim size is of Rs 13,070 and 40% of all payments so far sanctioned have been towards heart procedures, reflecting the noncommunicable disease burden of India, something that has been well documented for some years now. The highest number of surgeries that have happened, though, are for the relatively low-key cataract.
There is a need to update the socio-economic caste census data but that will have to wait after the election campaign, which is likely to highlight the programme rather than those details. The 71st Round of National Sample Survey Organisation (NSSO) has found 85.9% of rural households and 82% of urban households have no access to healthcare insurance/assurance. More than 17% of the Indian population spend at least 10% of their household budgets on health services. Healthcare-related expenditure pushes families into debt, with more than 24% households in rural India and 18% in urban area having met their healthcare expenses through some kind of borrowings.
That is why the government hopes that the fear of impoverishment because of health expenditures is acute enough for people to vote for a health insurance-cum-assurance scheme. If their hopes do not fructify, it could mean that the road to higher public expenditure on healthcare in India would get more uphill from here.