A major American think tank has given a cautious vote of confidence in the Modi government’s flagship health insurance initiative, the Pradhan Mantri-Jan Arogya Yojana (PMJAY) – popularly known as Ayushman Bharat, or Modicare.
The Washington D.C.-based Center for Global Development (CGD) credits the initiative with “[putting] healthcare within reach for hundreds of millions, significantly increasing the number of people who have government-funded health insurance and far exceeding the initial estimates”, according to the CGD’s chief operating officer Amanda Glassman. However, the government needs to do more to make sure that the scheme is sustainable, the think tank notes. “There’s still lots of work to do to bring down costs and bring up quality,” Glassman said.
The appraisal of Ayushman Bharat comes against the backdrop of the Lok Sabha polls, in which healthcare has been highlighted by both major parties as an issue of note. The governing BJP took the opportunity at the beginning of the elections to tout progress made under the scheme, with Union Minister for Health and Family Welfare J. P. Nadda claiming twenty lakh Indians benefited from the initiative in its first 200 days.
Congress, on the other hand, has criticised the scheme. Party leader Rahul Gandhi said the scheme amounted to “a handout to the fifteen to twenty richest businessmen in India” owing to its insurance-based model. Accordingly, Congress offered an alternative vision for health, including reforming healthcare with a Right to Healthcare Act and doubling government spending on healthcare to three percent of gross domestic product. Other political rivals have challenged the scheme, such as West Bengal Chief Minister Mamata Banerjee and the government in Delhi, both of whom are among multiple states to have declined to enact Ayushman Bharat in their respective jurisdictions.
The CGD’s verdict comes on the heels of praise by World Health Organization Director General Tedros Adhanom Ghebreyesus and philanthropist Bill Gates. However, it has also faced numerous reservations – not only from the BJP’s political opponents, but also from economists and healthcare experts. Perhaps most notably, Nobel laureate in economics Amartya Sen called the initiative “the biggest example of a leap in the wrong direction” and said the scheme will do little to effect the “radical change of primary healthcare” the sector needs in India.
Many of the judgements made by the CGD echo those reservations, including doubts about the sustainability of the scheme’s funding which accounted for a significant chunk of money apportioned to health and development in this year’s Union Budget. Concerns over the financing model surrounding Ayushman Bharat have dogged it ever since it was announced and, while the scheme has made progress if the government is to be believed, it continues to face issues. The CGD emphasises the scheme’s potential, but also its shortcomings – and the latter must be addressed if Ayushman Bharat has any chance of making India healthy.