Ayushman Bharat has recently celebrated the first anniversary since its launch. While controversial in some states, the scheme has drawn praise both at home and abroad and allowed medical services to be availed by tens of lakhs of Indians across the country. The AYUSH (Ayurvedic, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) Ministry has proposed the inclusion of additional packages under the scheme that would involve the addition of the first non-allopathic treatments to the list of available services. Such a move may prove controversial, as funds could begin to be allocated to services which are of dubious scientific backing.
Officially known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), Ayushman Bharat offers health insurance coverage of Rs 5 lakh per family per year to economically vulnerable families — covering roughly fifty crore Indians. Over the course of its first year, the programme has dispensed hospital treatments worth Rs 7,500 crore to beneficiaries, with the number of treatments numbering at roughly 46.4 lakh. Families have reportedly reaped savings of more than Rs 12,000 crore due to decreased need for out-of-pocket spending on healthcare.
Inclusion of AYUSH: A distraction from effective care?
“A proposal for inclusion of nineteen AYUSH packages has been finalised and submitted to the National Health Authority,” said Shripad Naik, Minister of State for AYUSH. Naik was critical of the fact that a patient availing allopathic treatment is eligible for medical insurance under PMJAY while the health cover is unavailable to the person who opts for alternative medicinal systems. The packages put forward include treatments through Panchakarma, cupping therapy and Varmam therapy. The packages aim to treat neurological diseases and arthritis, among others, though as of yet details are sparse.
Varmam therapy involves the use of massage to stimulate pressure points of the body, which is believed to promote healing. While the system is considered an “ancient wisdom”, its effects have only been studied to a limited degree. Small-scale studies conducted on groups numbering at only thirty individuals have suggested it to be an effective therapy. Other pieces of literature on Varmam therapy amount to little more than a paper written in reverence of an age-old practice with no manner of evidence to suggest its efficacy.
Panchakarma is a more broad detoxification process which involves various procedures such as massage, herbal enemas and behavioural changes towards diet and exercise. Again, the scope of studies into the therapy are limited. Some suggest physiological changes are insignificant, though have noted the potential for an increase in mood and perceived social support following treatment.
In a similar manner to other AYUSH therapies, cupping therapy – where cups are placed onto the skin after being heated to create suction – also suffers from a lack of evidence. While some reports have suggested minor benefits, they also note that – due to the nature of the treatment – it is all but impossible to include a negative control group and so any changes may be entirely due to a placebo effect. In fact, some potential adverse effects are associated with cupping therapy, including worsening skin conditions such as eczema and psoriasis and causing burns, skin discolouration, and scarring.
Adhering to proven treatment
The lack of evidence for any of these treatments does nothing to put forward the case for their addition to PMJAY. As of yet, the scheme has exclusively offered allopathic treatments.
It is questionable – to say the least – for the scheme branch out into unproven AYUSH treatments and otherwise controversial methods of treatment. Individuals wishing to avail therapies such as suction therapy and Panchakarma have the right to do so. Whether this should be subsidised by the government is another matter.
Indeed, it is worth noting not only what PMJAY does cover at present and may cover in the future, but also what it does not cover. PMJAY allows beneficiaries to access a range of treatments free of charge, yet does not extend this benefit to every current allopathic therapy available in India. For the scheme to provide AYUSH treatments while not providing proven allopathic therapies would be to knowingly put lives on the line by disadvantaging those with certain conditions.
Shripad Naik noted that In the past hundred days, the Central Research Councils of Ayurveda, Unani and Siddha have validated 110 classical formulations for sixty different conditions, by generating evidence on clinical safety and efficacy. However, clinical studies on many AYUSH therapies are still all but absent, casting a shadow of doubt over the evidence generated by the AYUSH Ministry. Indeed, in India, efforts have been underway by the AYUSH Ministry to restrict investigation of alternative medicine by non-AYUSH practitioners.
PMJAY represents the single largest government healthcare scheme the world has ever witnessed. The figures already indicate that vast numbers of Indians who may have otherwise not been able to avail treatment have benefitted from the scheme. If it is to continue along this success story, the scheme must remain focused and allocate financial resources to proven therapies that will be of the greatest benefit to healthcare in India.