Why I will not participate in Ayushman Bharat NHPS

The current ranking India has got in the World Health Statistics 2018 published by WHO in terms of healthcare indices, is a serious matter of concern not only for India but also the world. India is among the worst laggards and with its population burden of nearly 130 crore it drags down the entire world’s progress towards the Sustainable Development Goals (SDG) 2030. With a Maternal Mortality of 174 atleast partly contributed by ham handed suppression of ultrasound use under PCPNDT Act it will take decades before India can match even Iran what to talk of countries like Finland.

Problem aptly highlighted by the WHO report is that the commitment a Government shows towards improving healthcare indices is directly related to the spending it does whether per capita(63$ India) or as percentage of GDP (3.4% India). Countries which are committed to improving healthcare spending much more than the countries like India where token measures and slogans supplant hard currency. Wishing India into 21 st century development goals by gimmicks is again what is being attempted through this Ayushman Bharat scheme. Unfortunately there is no audit or accountability fixed in such schemes and though the basic structure of the scheme is flawed and it is being inadequately funded the blame for failure to provide services promised by the Government will be laid at the door of the medical professionals.

Let us look at the nitty gritty of the tendering process for insurance companies being undertaken for this Grand healthcare scheme. As per the document certain rates have been finalised for various procedure cost of the package for a caesarean delivery (Sr No 11) inclusive of medicines, disposables, 5 days hospital stay and investigations if any is princely Rs 9000. Laproscopic Cholecystectomy (serial no 182) has been fixed at Rs 15000 and Appendicectomy with Appendicular abscess drainage (serial no 201) has been pegged at Rs 12000. These rates are unrealistic, politically motivated, and will make healthcare establishments unviable. Low rates coupled with delayed payments have been the reason for failure of previous such schemes. Also keeping the recent trend of flagrant generosity shown by consumer courts towards complainants one award of 1 crore plus in a caesarean death will cause many hospitals to close.

These rates and the premium that the Government is negotiating with insurance firms for this scheme ranging around 1250 to 2500 per family reveals a massive political gimmick and fraud with the public. Assuring approximately 50 crore population that their healthcare needs will be taken care of free of cost by the Government but actually spending only 12500 crore which works out to 250 Rs or 3.6 USD per capita is a fraud of gargantuan proportions. People are being assured that just by showing cards without even a preauthorization their emergency needs will be taken care of by empanelled centres. This will lead to unrealistic expectations, worsening of doctor patient relationship and increase in violence. What then is the difference between the Government and the scamster who collected crores by claiming to sell smartphones at 251 Rs. It is outright fraud If a service which cannot be provided for less than 1.5 lac crore is claimed to be provided in 12500 crore through impressive bureaucratic jugglery all the while knowing that the service being promised will break the Insurance Company’s back and Doctors will be blamed for not providing services which Government promised.

Also the strident claims of corruption in healthcare also has genesis in the low rates provided by insurance companies and such schemes. Hospitals are forced to do fraudulent billing for procedures not needed, drugs not used in connivance with the insurers and implementing authorities simply to break even for procedures which cost more than what is paid for them. Once a system is setup for fraudulent billing then the systems encompasses all patients cashless, insured as well as the out of pocket paying variety. To check corruption it is absolutely essential that fair rates are given in the Ayushmann Bharat scheme otherwise in a scheme this magnitude disaster is foreseeable. Given its current form I for one will not opt to participate in this Grand Indian Ayushman Bharat Scheme but will continue doing my duty to my nation in the ways I have done in the past.

Dr Neeraj Nagpal 
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity,
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
1184, Sector 21 B Chandigarh 
09316517176 , 9814013735
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