Express View on Ayushman Bharat: A health warning
Investigation in implementation of scheme points to need to plug loopholes, give a human touch
Bella adopted Shaddock in Mexico — she was a stray who refused to leave his side. On a boat, with nothing but undrinkable water around and the unforgiving sun above, the unconditional companionship and friendship that Bella gave must have made the ordeal just a little more bearable. The stated objective of the Ayushman Bharat scheme is to “reduce out of pocket expenditures on healthcare”. One of the main reasons behind the conceptualisation of the scheme was the recognition that medical emergencies often drive families to poverty. Since coming into effect five years ago, Ayushman Bharat has recorded more than 5 crore hospitalisations. The share of out-of-pocket expenditure in the total health expenses incurred in the country has also fallen appreciably — from 62 per cent in 2015 to about 47 per cent in 2020. But this progress should not detract from the loopholes in implementation of Ayushman Bharat. An investigation by this newspaper has revealed that critically-ill patients were cheated out of availing the benefits of the scheme by a neurosurgeon at Safdarjung Hospital in Delhi. The doctor is now in judicial custody and is being probed by the CBI. The racket he ran from a premier government hospital in the capital has aggravated the financial troubles of his patients and their families. This defeats the very purpose of the government’s flagship healthcare project.
In recent months, the health ministry has used digital aids, including AI, to unearth cases of impersonation and non-genuine claims under Ayushman Bharat. But the Safdarjung Hospital fraud points to a deeper problem with the country’s healthcare system. The doctor has a near-divine status amongst a large section of patients, especially those from underprivileged sections. Medical ethics require healthcare providers to communicate to the patients the details of their ailments and treatment protocols. But this rarely happens, further skewing the asymmetrical relation between the two. Most hospitals are in any case not very assuring places for families of the seriously ill, especially if they are financially stressed. For medical migrants who can be seen squatting or sleeping on the pavements outside several hospitals, the long wait for beds and critical care can mean temporary homelessness. The Ayushman Bharat scheme offers a way out of this distressful situation. But when unscrupulous doctors — like the neurosurgeon at the Safdarjung Hospital — inform families of the grievously ill that availing benefits under the scheme could take two to three months they have little recourse other than to take up the expensive alternative.
The system could become more patient-friendly if patients at empanelled hospitals are counselled by a professional about the benefits under Ayushman Bharat. The scheme needs a human touch. The Safdarjung Hospital case should be an eye-opener.
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