GS Paper II

News Excerpt:

Recently, an investigation of official records and data obtained under the Right to Information revealed that over half of Ayushman Bharat beneficiaries used the scheme to access private care and particularly 53% patients used it in five southern states.

About Ayushman Bharat PM Jan Aushadhi Yojna; AB-PMJAY:

• 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). 
• Government hospitals account for 58% of all facilities empanelled.
• Launched in September 2018, it aims to achieve universal health coverage and substantially decrease out-of-pocket healthcare expenses among the poor, for whom a health emergency often leads to further impoverishment and debts.The cashless and paperless scheme offers up to Rs 5 lakh annually per family for hospitalisations in 27,000 empanelled secondary (hospitals with basic specialties including medicine, gynaecology) and 
• tertiary (super-specialty, like neurosurgery, cardiology, orthopaedics) healthcare facilities, with the benefits extending nationwide and without restrictions on family size, age, or gender.
• The scheme covers nearly 2,000 procedures and provides critical illness coverage for patients suffering from cancer, heart and liver diseases, among many more. 
• Besides the expenses incurred during the hospitalisation, the scheme covers three days of pre-hospitalisation and 15 days post-hospitalisation expenses such as diagnostics and medicines.
• Beneficiary families are identified from the 2011 Socio-Economic Caste Census (SECC), based on specific deprivation and occupational criteria across both rural and urban areas. 

Current Scenario of the scheme: Scale and Spread

In terms of people (Beneficiaries):

• The southern states of Tamil Nadu, Kerala, Karnataka, Andhra Pradesh, and Telangana together have just 17 percent of Ayushman cards nationwide, but account for a substantial 53 percent of the total patients in the country. 
• This indicates the widespread utilisation of the scheme in the southern region.
• And nearly 60 per cent of the total 5.47 crore patients who availed of the scheme over five years were from five states — Karnataka, Tamil Nadu, Kerala, Andhra Pradesh and Chhattisgarh.
• This suggests that despite controversies between the Centre and Opposition-ruled states over schemes and funding, the impact of the Ayushman Bharat scheme is not limited to states governed by the ruling party at the Centre.

• There are around 13.44 crore families (65 crore people) that are potential beneficiaries of the scheme. So far, 32.40 crore people have been issued Ayushman Bharat cards.
• The data reveals that a big chunk of the 2.95 crore beneficiaries who accessed treatment at private facilities were concentrated in just five states: - 
• Tamil Nadu (71.95 lakh patients), Andhra Pradesh (35.78 lakh patients), Uttar Pradesh (25.57 lakh patients), Gujarat (23.04 lakh patients) and Kerala (21.31 lakh patients)
• This points to disparities across states in access to healthcare services.
• An analysis of data and documents obtained through the Right to Information (RTI) Act shows that between 2018 and 2023, 5.47 crore patients accessed treatment under the scheme. 
• The annual average hovered around 49 lakh patients in the first three years, the subsequent three years saw a surge, with an average of 1.33 crore patients accessing treatments through the scheme annually.
• In Post covid era: In 2022-23, 64.96 lakh patients opted for private facilities, whereas 70.69 lakh chose government ones. 
• The following year, 2023-24, 57.56 lakh patients preferred private facilities, while 70.89 lakh took the government route.

In terms of money (expenditure):

• The data shows that the government incurred an expenditure of Rs 72,817.76 crore for treating patients under the scheme, of which Rs 48,778.61 crore or over 66% was spent for treatment at private facilities.

• • Of this total expenditure incurred for treatment at private facilities, 59% was in just five states: Andhra Pradesh, Gujarat, Madhya Pradesh, Uttar Pradesh, and Tamil Nadu.
• In the post covid era: In the last two financial years, there is a shift towards government facilities among patients accessing treatment under the scheme but not in spending.
  • In 2022-23, Rs 13,213.13 crore was spent on treatments in private facilities, dwarfing the Rs 7,055.12 crore spent at government hospitals. 
  • Similarly, in 2023-24, Rs 12,947.42 crore spent for treatments at private facilities in contrast to Rs 6,528.33 crore spent at government ones.

In terms of Hospitals (Govt & Private):

• It’s the private sector that saw a bulk of the 5.47 crore patients over the last five years.
• 60% empanelled hospitals are government-run, when it came to hospitalisation, 54% or 2.95 crore patients of the total 5.47 crore accessed private hospitals for treatment under the scheme.
• Four states: - Uttar Pradesh, Bihar, Haryana, and Madhya Pradesh account for close to 24% of the total empanelled government hospitals, only 11% of the total patients accessed treatment in government hospitals in these states.
• Four states: - Kerala, Jammu & Kashmir, Punjab, and Jharkhand that together account for a mere 5% of total empanelled government hospitals, however, served 22% of the total patients seeking treatment at government facilities nationally. 

Conclusion:

Ayushman Bharat has made significant strides in providing healthcare access to millions, especially in southern states. However, disparities in healthcare utilization and expenditure across states persist. Strengthening public healthcare infrastructure, improving access to government hospitals, and ensuring equitable healthcare distribution are crucial for the scheme's success in achieving universal health coverage.