Poor Prognosis

All is not well with Modi’s flagship health scheme

01 March 2019
Ayushman Bharat seeks to provide health cover to 107.4 million families, or around half a billion people.
Ayushman Bharat seeks to provide health cover to 107.4 million families, or around half a billion people.

Dalli–Rajhara is a small town in the Balod district of Chhattisgarh, home to iron-ore mines that feed the Bhilai steel plant. Situated in the town is the Shaheed hospital, famous for being run for, and by, mine workers. While it provides many services—such as internal medicine, surgery and psychiatry—the mainstay of the hospital is its department of obstetrics and gynaecology. Dr Saibal Jana, one of the founders, has been carrying out deliveries since the hospital was established in 1983. Pregnant women travel as far as a hundred kilometres in the hope of a safe delivery at the hospital.

The Shaheed hospital was initially financed by mine workers. They were inspired by Shankar Guha Niyogi, who founded the Chhattisgarh Mines Shramik Sangh, a trade union for miners, in 1977. The hospital was named after the 11 striking contract workers killed in police firing that year. Although the hospital excelled in its services, it did not grow significantly until the early 2000s, due to a lack of funds. Its clientele was restricted to the mine workers, and villagers from nearby districts. It charged its patients a minimal amount in order to sustain itself.

The hospital’s fate started to change in 2008, with the introduction of the Rashtriya Swasthya Bima Yojana, a health-insurance programme started by the then Congress-led central government. The Shaheed hospital was empanelled with the RSBY, under which the prescribed rates for procedures were significantly higher than what it was charging its patients. As it was receiving a large number of patients who were below the poverty line, and therefore eligible to file an insurance claim, the management started to use the surplus amount to develop the hospital. Since then, the hospital has added a new multistorey building, with dedicated wards for maternal and child health, and another one to house its junior doctors.

Despite having benefitted from the judicious use of insurance funds, doctors at the Shaheed hospital were sceptical about Ayushman Bharat, the national health-insurance scheme introduced, in September 2018, by the Narendra Modi government. Claiming funds under the RSBY was a simple affair—anyone with an RSBY card could receive free treatment immediately, on payment of a small administrative charge. However, Jana told me in January, “Ayushman Bharat has come with new processes, which makes funding of treatment more difficult.”

Every empanelled hospital is assigned a help desk for patients wishing to benefit from the scheme. “They sit from 9 am to 5 pm,” Jana said. The patients who arrive outside these hours have to wait until the following day to meet the arogya mitra—literally, “friend of health,” the title given to government-appointed facilitators of the scheme. “They are uncertain till the next day whether they have to pay themselves, or through the scheme,” Jana continued. “Many times, patients do not carry all the documents, such as ID proof. They have to go back to the village to get them.” As a result, they run afoul of another rule. “Insurance under Ayushman Bharat has to be claimed within 24 hours of hospitalisation,” Jana said. “If the residence of the patient is too far, she cannot get the documents in the stipulated time.” This rule, according to Jana, affects pregnant women the worst.

Jyotsna Singh is a health writer based in Delhi. She has been writing on health-related issues for the past eight years.

Keywords: Elections 2019 Ayushman Bharat Narendra Modi PMJAY interim budget Private Sector Shaheed hospital