The Indian government has just launched its much anticipated heathcare scheme :Pradhan Mantri Jan Arogya Yojana (PMJAY). Maybe they got the idea from the US, where the debate around a government funded/susbsidized public healthcare system has been going on for decades, leading up the current right-wing government cancelling the Affordable Care Act. One of the reasons why half of the US, thats the republicans, was against it was because there was no clear mention of how such a large program would be funded. They were clearly against the idea of funding the programme from taxes of the rich, inorder to pay for the health of the poor. The US remains the only OECD country which does not have universal healthcare, while even developing countries like Brazil, Mexico and Sri Lanka have UHC.
And so the idea of the world's largest democracy too achieving this goal of UHC is being beaten out of proportion. This is going to be the incumbent government's flagship contribution, if one slyly omits the demonitization fiasco. But the fact remains, not everyone is going to benefit from it. And no-one is questioning how such a programme will be funded.
The governmen says 50 crore individuals will benefit from it. Ok. As of now, the total population of India is 1,354,051,854. Thats 135 crore. 50 crore of that rounds down to 37% of the population. Just about a third of the burgeoning population. And if one looks at the eligibility criteria, that is only the poorest of the poor of the society stands to be eligible. For the urban areas, they actually mention eligible occupations as rag pickers and beggars among others ! So clearyly, this is not a 'universal' program, and instead aims to provide a minimum for the section of the society that needs healthcare the most.
But the even more murky area is regarding how they plan to fund this. Healthcare in India is not cheap. Even with all the copy-cat medications and unlicensed drugs and doctors, quality healthcare still works out to be expensive. Combined with malnutrition, India is facing direct threats on two fronts – infectious diseases like tuberculosis, malaria, H1N1 and drug-resistant TB and the emergence of non-communicable ‘lifestyle’ diseases like heart ailments, diabetes and cancer.This has put the country’s arbitrarily distributed healthcare sector under pressure. It’s exacerbated by the fact that out-of-pocket expenditure on healthcare drove 55 million people in poverty in 2017.
It may be recalled that PMJAY is one of the two components of Ayushman Bharat, the Modi government’s flagship health initiative. The other component is the creation of 1,50,000 “health and wellness centres”. The finance minister allocated Rs 1,200 crore for these centres in 2018-19. That comes to Rs 80,000 per centre. Essentially, it is just a new coat of paint for the old primary health centres, which are being renamed for the occasion.
At the moment, the fund allocated is 2000 crore, to cover 50 crore Indians. That works down to 40 rupees per person for the whole year. According to recent media reports, NITI Aayog experts anticipate the annual PMJAY budget to rise to Rs 10,000 crore or so in the next few years, or something in that range. But Rs 10,000 crore (more than five times the current PMJAY budget) is still chickenfeed for the purpose of providing health insurance to 10 crore families. It comes to Rs 1,000 per family, or Rs 200 per person. For the whole year.
How would you feel if you were told you that your budget for health care this year is Rs 200? An illusion has been created that putting this money in an insurance premium has some sort of multiplier effect. This is not the case at all. Insurance can help to redistribute health expenditure towards those who need it most, but it cannot turn Rs 200 into more. If the government spends only Rs 200 per person on health insurance, that’s the amount of health care an average person gets.
True Universal Healthcare in India is still a long time away. Maybe this election gimmick is one step in that long-term direction.
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