Delhi rejects Modi govt’s Ayushman Bharat, plans to launch better health scheme

Delhi’s Aam Aadmi Party (AAP) government on Friday refused to be a part of the Ayushman Bharat scheme, saying the Centre’s flagship national health protection scheme (NHPS) would not offer cover to enough people and that the state would work towards implementing its own health insurance scheme instead.

Ayushman Bharat, often referred to as ‘Modicare’, is expected to be launched by the Union government on August 15. It aims to provide health insurance cover of up to Rs 5 lakh to 500 million “poor and vulnerable” Indians. Under the scheme, the states will have to pay for 40% of the funds disbursed, while the Centre will contribute the rest.

“The state government does not agree with the Centre’s health insurance scheme because it is bound to exclude a majority of Delhi’s population who need it. The Delhi government will work towards implementing its own health insurance scheme,” Dr Kirti Bhushan, director general of health services, Delhi government, said on Friday.

“Under NHPS, the government will cover beneficiaries according to the socio-economic caste census of 2011. The population of Delhi is rapidly growing and greatly varies from what it was in 2011. So, providing insurance on the basis of that data will be a flawed practice,” he added.

She also pointed out that 73.4% of all the households surveyed by SECC were for rural India, while Delhi only has 8% of rural population.

When contacted, Ayushman Bharat CEO Dr Indu Bhushan, however, said that the Delhi government hasn’t officially conveyed anything about not signing the scheme to her department. “I had a review meeting today, where I was told that Delhi would sign after their assembly session ends today,” he said.

Only eight states are yet to come on board with the Central scheme — Odisha, Punjab, Tamil Nadu, Kerala, Karnataka, Telangana, Maharashtra and Delhi. Public health is a state subject, according to the Indian Constitution.

While Odisha has launched a parallel scheme that offers hospitalisation cover of up to Rs 5 lakh to men and Rs 7 lakh to women, “the other states have agreed and are in the process of signing”, Dr Indu Bhushan said.

The Delhi government has allocated Rs 100 crore in this year’s budget for the state insurance scheme that will provide a cover of Rs 1 lakh per family per year for most illnesses that need hospitalisation and Rs 2-4 lakh for critical illnesses. According to Delhi health minister Satyendar Jain, between 1,700-1,800 illnesses and conditions will be listed as ‘critical’.

A government official familiar with the developments said that the insurance scheme to be launched by the Delhi government will also include beneficiaries who show National Food Security cards and have electricity connection load below 2 kilowatts. The officials claimed that this will widen the beneficiary net to include 1.2 crore people as opposed to the 35 lakh people (7 lakh families) who would receive insurance cover if the Centre’s norms were followed.

“It should not be either/ or; the state government should utilise funds from the centre to augment their own scheme. Combining the two, if possible, would help in making the scheme more workable as several of the package rates that have been proposed are way below the market rates and hospitals may not be able to or want to operate on those costs. Also, it is important to not have the 1 lakh or 5 lakh cap on the insurance cover uniformly for all. Rather the schemes must look at disease category wise cover because, for example, a person who undergoes an organ or bone marrow transplant will need expensive medicines for life, but that is not true for someone who has undergone other routine surgeries,” said Dr MC Mishra, former director of All India Institute of Medical Science.