This is an archive article published on March 9, 2024
Ayushman Bharat: Cuts expenses, expands health care net, gives Centre imprint across states
The study of the RTI data reveals this and more. Particularly, states in the south, ruled mostly by Opposition parties, which already had their own insurance schemes and relatively better healthcare infrastructure, have made the most of the Ayushman scheme.
The scheme is jointly funded by the Centre and the states in the ratio 60:40 (90:10 in the case of North-East and hilly states). (Express Archives)
Over time, Prime Minister Narendra Modi’s references to the Ayushman Bharat health insurance scheme launched in September 2018, point to three key takeaways.
One, the scheme holds promise in reducing out-of-pocket expenditure of the poor. Two, it provides patients and their families access to critical medical treatments and emergency care that were previously financially unattainable. Three, its influence is most pronounced in marginalised communities, particularly Scheduled Tribes.
From a political standpoint, Modi has underscored that the scheme is integral to building trust. While health is a state subject, this scheme has allowed him to make the Central government a key stakeholder in providing access to free healthcare to citizens across states, irrespective of which party is in power.
The study of the RTI data reveals this and more. Particularly, states in the south, ruled mostly by Opposition parties, which already had their own insurance schemes and relatively better healthcare infrastructure, have made the most of the Ayushman scheme.
In states like Bihar, Jharkhand, Madhya Pradesh, Maharashtra, and Uttar Pradesh, which had low health insurance coverage before the launch of Ayushman Bharat, the scheme has brought benefits to a significant portion of their population.
Data also shows its impact on cutting household expenditure on health. Out-of-pocket expenditure in 2014-15 was as high as 62.6 per cent of the total health expenditure for a household. In 2019-20, two years after the launch of the scheme, this dropped to 47 per cent of the total health expenditure. These are early signs and data of later years once available will shed more light on this trend.
This decline can be partly attributed to a substantial increase in social expenditure on health, encompassing government allocations for premiums or budgets designated for health insurance schemes like the PMJAY. Indeed, social security expenditure on health has risen to 9.3 per cent in 2019-20 from 5.7% in 2014-15.
And it is socio-economically disadvantaged groups that benefit the most.
A considerable portion of the scheme’s beneficiaries are from the scheduled castes, scheduled tribes, and other backward castes, which have to endure a disproportionate burden in terms of medical costs relative to their incomes. During hospital stays, for instance, the average medical expenditure per case of hospitalisation for rural SC individuals amounts to Rs 11,315, while their urban counterparts spend Rs 18,380. For STs, it is Rs 14,857 in rural areas and Rs 19,492 in urban centers, and for OBCs, Rs 16,114 in rural regions and Rs 21,778 in urban settings. Annual coverage of Rs 5 lakh provided by the scheme can, therefore, substantively mitigate their out-of-pocket expenditure.
Kaunain Sheriff M is an award-winning investigative journalist and the National Health Editor at The Indian Express. He is the author of Johnson & Johnson Files: The Indian Secrets of a Global Giant, an investigation into one of the world’s most powerful pharmaceutical companies.
With over a decade of experience, Kaunain brings deep expertise in three areas of investigative journalism: law, health, and data. He currently leads The Indian Express newsroom’s in-depth coverage of health.
His work has earned some of the most prestigious honours in journalism, including the Ramnath Goenka Award for Excellence in Journalism, the Society of Publishers in Asia (SOPA) Award, and the Mumbai Press Club’s Red Ink Award.
Kaunain has also collaborated on major global investigations. He was part of the Implant Files project with the International Consortium of Investigative Journalists (ICIJ), which exposed malpractices in the medical device industry across the world. He also contributed to an international investigation that uncovered how a Chinese big-data firm was monitoring thousands of prominent Indian individuals and institutions in real time.
Over the years, he has reported on several high-profile criminal trials, including the Hashimpura massacre, the 2G spectrum scam, and the coal block allocation case. Within The Indian Express, he has been honoured three times with the Indian Express Excellence Award for his investigations—on the anti-Sikh riots, the Vyapam exam scam, and the abuse of the National Security Act in Uttar Pradesh. ... Read More
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