An old man committed suicide after being denied the benefits of Ayushman Bharat Yojana

By Prabha

A 72-year-old man in Bengaluru committed suicide on December 25 after being denied the benefits of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). He had gastric cancer. The case of his suicide came to light in the media on Thursday. According to the report, the victim was a retired state government employee. The report said that the patient was further shocked when he came to know that the hospital refused to give him a cover of ₹5 lakh under the Ayushman Bharat Senior Citizen Scheme. The age limit of senior citizens in this scheme was recently increased by the Center.
This news of Bengaluru remained buried in some corner of the newspaper pages. TV channels do not care about such news. Ayushman Bharat Yojana has been implemented in all BJP states. But in no state are hospitals giving benefits to the poor under this scheme. The government does not have time to review this scheme, even in BJP ruled states.

When PM Modi mentioned the Ayushman Bharat scheme in his Mann Ki Baat radio programme, he said that he wanted to solve the crisis of millions of poor citizens who have been living their lives for decades “surrounded by constant worry. What if they fall ill, will they get treatment, or worry about earning bread for the family?

The Prime Minister may have meant well but why does his thinking not seem to be reflected in the benefits of this scheme. Ayushman Bharat fails to recognise and compensate for the indirect costs associated with hospitalisation. So it is of no use to the poor.

Situation in UP
In some district hospitals of UP, not a single treatment has been done under this scheme for a long time. The central government itself had advised Uttar Pradesh, which is lagging behind in the implementation of Ayushman Bharat Yojana, to ‘improve the situation’. But the situation never improved.

“The biggest drawback of this scheme is the lack of activity of public hospitals. Whereas this scheme should have been successful in government hospitals. Private hospitals are also not interested in the scheme due to delay in payment of dues. The figures of this scheme are poor in most BJP ruled states. But UP is on top.

The central government has been asking UP since 2020 to triple the number of daily treatments under this scheme. The reach of the medical insurance scheme in UP is anyway low. Because most of the public hospitals are overburdened. They are unable to handle the pressure of patients. More than one crore beneficiary families of Ayushman Yojana are being reported in UP while the actual people getting the benefit of the scheme are not even 1000. There are many flaws in the Ayushman scheme, making it difficult for the needy poor to get treatment. Out of the claims of Rs 7,602 crore raised across the country under the scheme in 2019, a large amount could not be approved. So far only 2,312 hospitals in UP are listed under the Ayushman Bharat scheme, which includes 842 public hospitals and 1,470 private hospitals. So far about 2,628 health and wellness centers are functioning in UP under this scheme. Needy patients are not only unable to get treatment under the Ayushman Bharat scheme, but are also deprived of treatment under the National Health Policy.

Gujarat situation

The condition of this scheme in UP has been discussed above. But the situation of BJP and Modi’s ideal state Gujarat is also not very good. Private hospitals in Gujarat have made this scheme brought for the poor a source of income. In the audit report of CAG (Comptroller and Auditor General) in 2023, irregularities were revealed in the hospitals of Gujarat under this scheme. Under the guise of treatment through this scheme, hospitals have charged lakhs of rupees from the government. According to the CAG report 2023, during the period from January 2021 to March 2021, auditors visited 50 hospitals in Gujarat and found irregularities.

Situation in Madhya Pradesh: The situation in BJP-ruled Madhya Pradesh is similar to that in UP and Gujarat. Like Gujarat, CAG also investigated Madhya Pradesh and found large-scale irregularities. According to the CAG report 2023, the investigation found that 447 patients were not treated and died. But private hospitals charged lakhs of rupees from the government. Hospitals for 8081 patients were found to be running simultaneously in several hospitals.

The National Human Rights Commission has sought a report from the Union Health Ministry on poor patients who are not able to get treatment under the Rashtriya Arogya Nidhi (RAN) even though they are beneficiaries of Ayushman Bharat. According to the NHRC, it has received complaints that patients holding BPL cards are not getting RAN benefits even though they are availing AB-PMJAY benefits.

There have also been cases where Ayushman Bharat beneficiaries were not able to avail treatment for blood cancer and chronic liver diseases as these are not covered under the flagship health insurance scheme. The Commission has asked the ministry to take appropriate action. The action taken is not known.

The central government expanded the Ayushman Bharat scheme in November to cover all senior citizens aged 70 years and above, irrespective of their income. Through this, senior citizens were given a free health insurance cover of Rs 5 lakh annually. The Modi government had claimed that about 4.5 crore families would benefit from this. But according to the news that came from Bengaluru, the age of the elderly person who did not get the benefit of this scheme was 72 years.

In an interview to the Economic Times, Colonel Sanjeev Govila (Retd), financial planner and CEO of the NGO Hum Fauji, said the reason for the scheme’s failure is the lack of enough quality hospitals in the network. Ayushman Bharat is primarily meant for the economically weaker sections, and the network of hospitals included in its panel is often limited to government and a few private hospitals. Colonel Sanjeev Govila says that if the preferred hospital or doctor is not part of the network, the quality and availability of specialised treatment for senior citizens will be compromised.

Many treatments are not even included
Hospitals often refuse to treat organ transplants, cosmetic surgeries and even some types of cancer to the beneficiaries of the Ayushman Bharat scheme. In such a situation, senior citizens do not get the benefit. It is necessary that the government makes the coverage comprehensive and flexible.