DNA Edit – Fatal expenses: Ayushman is exposing India’s health fault lines

As the Pradhan Mantri Jan Arogya Yojana, better known as Ayushman Bharat, unfolds after its September launch, details that are emerging expose gaping holes in India’s health infrastructure. For instance, access to health care is marred by huge out-of-pocket expenses that pushes nearly 7 per cent of households across the country, into poverty every year. This claim made by Ayushman Bharat’s CEO, suggests the glaring contrast and the incredible diversity in population that needs health care. For instance, while 70 per cent of India’s population lives in rural areas, the majority of tertiary healthcare services, also the most expensive in terms of out-of-pocket expenses, are available in urban areas. Well, it is a good time to welcome Ayushman, which is geared towards reducing ballooning expenditure for hospitalisation. 

Perhaps the moment has come to tilt this bias in favour of rural areas, where the vast majority of the country resides. One good way - proposed many times in the past with some degree of success, however limited - is to focus on primary health centres (PHCs) in far flung areas of the country and empower them financially. The way is certainly not easy, given that it caters essentially to the un-empowered and the unlettered, whose financial means are strictly limited. Ultimately however, it is the PHC’s that constitute the backbone of the country’s system and it is here that the most ambitious mega health programme like Ayushman needs to leave its imprimatur. Clearly, as it unfolds through the length and breadth of the land, this programme will be revealing the many fault lines that need careful handling. The good thing is that someone is at least trying.