It has been a fortnight since the Union finance minister announced the government’s vision of Ayushman Bharat, or the National Health Protection Scheme (NHPS), assuring 100 million families of coverage of up to Rs5 lakh for secondary and tertiary care.

Meanwhile, in a welcome departure from previous years, health has emerged as the central topic of post-budget analysis and critique. Media newsrooms have been brimming with policymakers, academics, industry executives and politicians explaining the details and mechanics of the NHPS. Valuable viewpoints, evidence and analysis have surfaced in plenty, laced with a mix of admiration and scepticism, and as a result, the NHPS has been labelled many things—visionary, populist, pro-private insurance market, suboptimal solution for universal health, scaled-up version of old schemes, pre-election gimmick, and more. 
 
What
  1. Conspicuous by its absence in these debates has been the voice of the customer—the reaction of those belonging to the 100 million households meant to be relieved by the NHPS of the financial hardship of paying for healthcare.
  2. The National Council of Applied Economic Research labels them “Deprived Households”. The annual income of these households lurks below Rs1.5 lakh. 
  3. Their homes, whether urban or rural, are in locations defined by wretched living conditions. And the people who call them home float freely between carefully-combed poverty zones separated by invisible poverty lines. 
  4. Some 135 million households fall in the deprived category, constituting 56% of the total households in India. And yet, there has appeared not a single report highlighting their opinion. 
  5. It is a theoretical exercise to predict their likely reaction to the NHPS, based on the established correlation between economic capacity, health-seeking behaviour, and the gamut of risk factors endangering well-being and health in the bubble of deprivation. 
  6. On an average, the medical expenses of such deprived households with low income capacity hover between 5-6% of total expenses. The pursuit of health may trap them in medium- or long-term therapy regimens, pulling this single-digit proportion into a catastrophic range of 10% or above. Hence, the majority of them do not report sickness, until rendered inactive to work and earn, either by injury or the flare-up of a chronic condition. 
  7. For rural dwellers, seeking health is not even a matter of choice if the nearest medical touch point (public or private) lies miles away. There are still others, who don’t trust the quality of available care to be worth dwindling family finances. 
  8. The top ailments adding the maximum burden of disease in EAG states include ischaemic heart diseases, lower respiratory tract infections such as bronchitis and asthma, chronic obstructive pulmonary disorder, tuberculosis and diarrhoeal diseases. 
  9. Most of these are chronic conditions that require regular outpatient consultations to manage disease prognosis. Hospitalization is a one-off event.