Making the missing middle visible
Spreading limited resources over a wider population is bound to result in more loopholes. The ultimate loser is the patient
Faced with escalating medical inflation, Prime Minister Modi’s recent expansion of health coverage under AB-PMJAY for citizens of and above 70 years, at a cost of Rs 3437 crore, is certainly a welcome step. This expansion is in line with the government’s aim to expand the scheme to the “missing middle”, which is approximately 30 per cent of the country’s population, around 400 million people, who according to an October 2021 NITI Aayog report, still do not have any medical insurance.
But though it is targeted at the estimated 6 crore senior citizens, under the Ayushman Vaya Vandana Card, health experts have pointed out that a health cover of Rs 5 lakh is not sufficient for the health needs of senior citizens.
Secondly, the government will have to ensure that sufficient infrastructure is put into place before expanding the scheme to other sections of the population. Though the PM also announced several initiatives worth more than Rs 12,855 crore, including projects worth more than Rs 5502 crore under the Ministry of Health & Family Welfare on the same day, these will take time to operationalise.
Prof V K Paul, Member, NITI Aayog’s assertion at the recent FICCI HEAL 2024 conference that the government is ready with extra capacity to handle the elderly through dignity, is a recognition that infrastructure will have to keep pace as the scheme expands.
Thirdly, the government will have to do more to plug the loopholes to prevent fraud. And fourthly, getting the private sector on board will mean assuring them of timely reimbursement, which has been the biggest reason why most private hospitals are reluctant to be part of AB-PMJAY.
Logically, spreading limited resources over a wider population is bound to result in more loopholes. The ultimate loser is the patient. Unless more funds are allocated to create and monitor more healthcare facilities, unless more providers are coaxed to join up, unless they have the confidence that the government will reimburse them fairly and timely, this announcement will remain on paper, benefiting a lucky minority who happen to live in urban areas.
Since health is a state subject, it is pertinent to track the health manifestos of states going in for elections. Maharashtra, for example, goes to the polls on November 20. The Indian Medical Association (IMA)’s Health Manifesto for Maharashtra, named “AROGYA JAHIRNAMA” has flagged nine issues, with suggestions and solutions.
IMA claims to be the largest non-governmental organisation of allopathic doctors in India, with a membership of four lakh doctors. Nearly 70 per cent of healthcare services in Maharashtra are provided by private hospitals. IMA has over 50000 members through 227 branches in the state, with most members providing healthcare services in small and medium hospitals in Maharashtra. Thus it’s fair to say that this list reflects a wide section of private practitioners.
The top issue flagged by the IMA is attacks on doctors and healthcare facilities. The IMA representation points out that although a law (since 2010) exists in Maharashtra to protect doctors, attacks on healthcare professionals continue to rise and believes that compared to other states, the law in Maharashtra remains ineffective and weak.
The manifesto makes 11 suggestions, including amendments to the present Maharashtra Medicare Act 2010, a minimum punishment of seven years of imprisonment and a compensation of up to Rs 5,00,000/- for medical professionals.
The suggestion to make the implementation of the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) scheme, Maharashtra’s health assurance scheme, more transparent and increasing the rates, echoes the criticism of the central AB-PMJAY scheme.
Other issues flagged include streamlining the hospital registration and renewal process and implementing a one-time fire department NOC. While IMA calls for streamlining of such registrations, claiming that repeated registrations lead to misuse and unnecessary bureaucratic paperwork, they do serve the purpose of monitoring the proper functioning of health facilities.
Bridging the divide between India and Bharat remains a challenge as highlighted by a recent report from FICCI-BDO India titled, ‘Expanding the Reach of Diagnostics: The Digital Advantage’ during the two-day ‘FICCI HEAL 2024’. The report points out that while the sector is likely to almost double, from the current USD 13 billion to USD 25 billion by 2028, the growth has been uneven, with significant disparities between urban and rural areas. Hopefully, digital and tele-diagnostics will help bridge this divide.
As we wind down 2024 and set out goals for 2025, one hopes that these inequities will be identified and addressed at speed.
Viveka Roychowdhury, Editor
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