Investigation: Does the Ayushman Bharat Card Offer Hope to the Needy?

New Delhi- The country's largest hospital, AIIMS, where people across the states come for treatment, often faces a shortage of beds. Many families find themselves struggling to find space, not only for their families or close relatives but also for the patients themselves. In such situations, some families spend their days and nights outside hospitals, near metro stations, within metro station premises, or even inside hospital premises where space is available.

In a concerted bid to enhance the healthcare infrastructure, the central government, recognizing the pivotal role of the Ayushman Bharat Yojana as a cornerstone, has embarked on this transformative initiative. This visionary scheme aims to extend free medical treatment, amounting to five lakh rupees annually, to every member of economically disadvantaged families. However, the implementation of this program comes with certain stipulations. Officially designated as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, the scheme has garnered nationwide attention. Notably, the Delhi government has opted out of participating in this initiative, citing confidence in its current healthcare provisions.

"I have epilepsy, and I've been undergoing treatment for many years. My family has spent lakhs on my treatment. Today, I came to the hospital and tried to find out if my treatment could be covered under Ayushman. However, despite asking multiple times, I faced disappointment," says Abhay Banerjee, a resident of West Delhi. He is frustrated, attempting to navigate through the hospital system alone. Even after spending a significant amount on treatment, he turned to Ayushman Bharat in the hope of some financial assistance at the central facility under the scheme. However, he expresses dissatisfaction with the Delhi government, stating, "If Ayushman Yojana is providing us with support of five lakhs, why doesn't the Delhi Chief Minister want to accept it?"

At the same time, a woman in a burqa sits alone, possibly waiting for her husband to gather information at the Ayushman Bharat center. She is dealing with advanced breast cancer and hails from Rampur, Uttar Pradesh. She mentions her attempts to get an Ayushman card but failed. Officials have told her that having her name on the labor card is essential. When she tried to add her name to the labor card, they claimed the website was not functioning. This has happened several times.

In a short while, her husband Anish joins her. They, too, have made efforts to get an Ayushman card but claim their names are not on the list. Anish says, "We tried to get it made in the village, but they say your name should be in the labor card. The labor card person says it should be in the ration card, and the ration card person says it should have six units, meaning there should be six members in the family, while we are only four."

The central government has always claimed that Ayushman Bharat is not just India's but the world's largest health insurance scheme. Launched in September 2018 from Ranchi, Jharkhand, the scheme issues an Ayushman card to every member of economically weaker families. These members can avail themselves of free treatment up to five lakh rupees, provided they are admitted to a hospital.

This scheme is applicable in all states of the country, except Delhi, Odisha, and West Bengal. Delhi Chief Minister Arvind Kejriwal has consistently opposed implementing the scheme in the capital, arguing that the state government is already providing good healthcare to Delhi residents. Kejriwal has labelled the scheme a scandal on multiple occasions.

Primarily from Vaishali, Bihar, Vinita has come to the hospital for her mother's treatment. She has been living in Delhi since her marriage. Since her father-in-law has a government job, she does not have an Ayushman card. However, her mother's treatment is being covered under this card. Her mother's knees and spine have weakened significantly, causing difficulties in walking and staying upright. She always wears a belt from her back to her waist.

She says, "I am happy with the Ayushman Bharat Yojana because it has provided significant help. Without it, we would have been unable to afford expensive treatment. When two square meals are a big deal for the poor, from where can we afford costly medical treatment? The good thing is that along with treatment, medicines are also provided for free."

In response to reason for not availing treatment in Bihar, Vinita mentions that they had taken her mother to hospitals in Patna as well, but the doctors there referred her to Delhi, claiming that better treatment could be provided here. However, the drawback is that admission is mandatory, unlike for those patients whose treatment can be done without admission but are not eligible for free treatment under this scheme.

Savita is sitting with her daughter, having come from Bulandshahr. She has come for her cataract operation. Her treatment is also covered under the Ayushman Bharat scheme.

At the Ayushman Bharat center in AIIMS, efforts were made to find people who have undergone treatment multiple times under Ayushman yojana. However, most of the people who came had sought treatment under the scheme for the first time. Therefore, their experience with the scheme was limited. Some came from Jammu, while others came from Punjab. People from almost every corner of the country had come for their treatment. Since this scheme is not applicable in Delhi, no local residents could be found there.

As per a comprehensive report from Mint , a pivotal development is on the horizon for the Ayushman Bharat Yojana, as the government contemplates a substantial increase in the coverage amount from five to ten lakh rupees starting February 2024. The news further underscores the widespread impact of the scheme, indicating that approximately 60 crore individuals, or 600 million people, have already reaped the benefits. Notably, Prime Minister Modi took pride in this milestone back in May 2020, commemorating the moment when beneficiaries crossed the one crore mark through a tweet.

However, a comprehensive investigation by the BBC unravelled a nuanced perspective on this development. Contrary to initial reports, the current CEO of Ayushman Bharat, Indu Bhushan, clarified that the Prime Minister's reference to one crore was not indicative of the number of beneficiaries but rather the frequency of medical treatments availed, reaching the one crore mark. This crucial clarification sheds light on the actual impact of the scheme, emphasizing that it is the frequency of healthcare utilization, not the sheer number of individuals, that accounts for the remarkable statistic of one crore.

Numerous studies have revealed that the benefits of health facilities or government schemes tend to reach marginalized populations last. People from deprived sections often struggle to access basic facilities. In a collaborative effort between the Social Justice Task Force (SJTF) and the Global Call to Action Against Poverty (GCAP) on vaccine equity, it was discovered that underprivileged individuals face challenges in accessing healthcare, leading to emerging inequities. In response to this initiative, there is a heightened focus on universal health coverage.

According to a paper published by Oxfam India, private infrastructure now constitutes approximately 62 percent of India's health infrastructure. However, only 4 percent of tribals and 15 percent of Dalits can afford private healthcare. Despite Dalits and tribals comprising more than 25 percent of India's population, private healthcare remains financially out of reach for them due to their classification in the lowest income group. News reports continually highlight extended waiting times for tests and surgeries in prominent hospitals like AIIMS. Over-reliance on the government health system forces the deprived and exploited sections of society to endure shorter and poorer quality lives.

According to a UN report, Dalit women live approximately 14 years less than upper-caste women, with the primary cause being the lack of proper health services. The research indicates that, on average, while upper-caste women live to be 54.1 years old, Dalit women have an average life expectancy of only 39.5 years. Marginalized communities confront systemic discrimination, denying them access to basic services, including health facilities.

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