By Business India Editorial

When it was first launched on September 22, 2018, Ayushman Bharat was supposed to be a game changer for the poor and underprivileged people of India. With its two components, namely the National Health Protection Scheme (NHPS) and 1.5 lakh wellness centres across the country, it was supposed to rejuvenate the nation’s broken down healthcare system. Its target: to benefit 50 crore people which was approximately 40 per cent of the country’s population by the end of 2022, when the scheme would be fully functional. Arogya Manthan 2.0, being held in the middle of this week, may therefore be considered a mid-term assessment of the plan.

According to available information about 12.55 crore people have benefited from the scheme, many of whom needed hospitalization for serious ailments such as heart valve disease, cancer, etc. Thus at the end of two years of the scheme, just about 25 per cent of the target population have derived the promised benefits. Could the number of actual beneficiaries then reach 50 crore by 2022?

If that happened, the conclusion would have to be that the entire target population becomes sick enough to require hospital admission within four years. Since NHPS is basically a health insurance scheme, this would imply a claims ratio of almost 25 per cent – something that no health insurance company can afford. So we can expect the NHPS to develop some of the ills of the Mediclaim policies of earlier years – lame excuses for rejecting claims, inordinate delays on settling the bills of hospitals that offer cashless insurance, etc.

Other statistical studies in various countries show that the frequency of any medical condition in a given population is 3-5 per cent. This may vary somewhat from one geographical area to another, from year to year and from one disease to another. A sudden rise in a particular disease in a specific area would be designated as an “outbreak.” But if none of these prevail, the frequency of 12.5 per cent people in a country being afflicted with serious illnesses is definitely a point to ponder.

So what is going wrong? First, there is little point in offering hospital care without an accompanying thrust in primary care. One reason why people seek hospitalization is that they are compelled to postpone their healthcare needs until it becomes unavoidable. By then, the illness too has turned serious enough. Unfortunately, sufficient progress is not visible in the Wellness component of Ayushman Bharat.