Prime Minister Narendra Modi’s flagship health insurance scheme, Ayushman Bharat, officially called the Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), has been widely lauded since it was launched last year. Various states are in the process of rolling it out. Its aim of picking up the illness bills of 500 million of the country’s most vulnerable is hard to argue against. But with the sorry spectacle presented by Bihar in dealing with a deadly encephalitis outbreak among children of poverty-stricken families, attention has been drawn back to the ramshackle state of public healthcare facilities. These remain abysmal in most parts of the country. There is a severe shortage of medical personnel, including doctors and nurses, as well as a dearth of hospitals and hospital beds. This shortage is especially stark in rural areas. In many places, primary health centres, community health centres, and sub-centres are located too far from people’s homes. Even in the big cities, patients often have to run from one hospital to another in search of a particular facility or a bed. Private infirmaries are the preferred option for most, if only because of treatment is assured. The poor, however, typically find themselves shut out not just by steep prices—which Ayushman Bharat expects to overcome—but also invisible class barriers. Sometimes, just the glower of a guard at a private clinic is enough to turn poor patients away.
Free or nominally priced public services as a right that anyone can invoke is the answer. But this requires the country to make public health services so easily accessible and of such reliable quality that only the well-off opt for the extra comfort of private sector facilities. Achieving this would be a long haul, no doubt, but several middle-income countries have done it. The government needs to upgrade healthcare infrastructure in the country at two levels. First, it must ensure that the quality of public healthcare services can be trusted by everyone, regardless of socio-economic status. Quality signals are best sent out by celebrities and public representatives using these facilities themselves, instead of, say, flying overseas for a routine operation. Second, the authorities must ensure that enough healthcare centres or hospitals are operational across the country within reasonable reach of residential areas— urban and rural. Along with the number of hospitals, the number of beds also needs to rise sharply. As of now, space tends to run out far too quickly in case of an epidemic. Unless India expands its health capacity by a high order of magnitude, insurance cover for the masses could begin to look like a cheque that isn’t easy to encash. The financial pooling of illness risks is all very well, but the wherewithal to deal with illness itself must come first.
By budget figures of the last fiscal year, India spends just a shade over 1% of its gross domestic product (GDP) on healthcare. This includes central expenditure on the Ayushman Bharat scheme. The Interim Budget for this year upped the percentage, but only slightly. The Prime Minister set a goal last year of 2.5% of GDP by 2025. This is the least the country deserves. For progress to be made towards that objective, however, this year’s budget due on 5 July would need to pencil in a significant hike in the country’s health outlay. Healthcare needs to be fixed in mission mode. Every child’s life claimed by a treatable disease is one life too many.