Ayushman for 70+: Good scheme despite glitches; but will private hospitals fleece govt coffers?

By Rajiv Shah

I was quite excited when Prime Minister Narendra Modi launched what was called "the expanded Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme" for those aged 70 and above, irrespective of their socio-economic status, with a benefit cover of Rs 5 lakh per year in empanelled hospitals across India.

Reportedly, the likely to benefit of the scheme are over 60 million senior citizens; it is part of the health projects worth Rs 12,850 crore launched by Modi about two weeks ago. However, the beneficiary base of the expansion is said to have been done with an outlay of Rs 3,437 crore.

I decided to enrol myself as a beneficiary since I also found myself to be eligible -- instead of visiting the local government office, I decided to do it sitting at home in Ahmedabad online, which I found from the internet was very much possible.

So I first downloaded the Ayushman app, and tried doing it there. I found it to be an extremely slow app, refusing to go forward easily. Not without reason, its rating is 3.6/5. Disappointed users comment, not only OTP verification at every step is "very disturbing", there is no back button, drop arrows are not opening, has "many glitches", skips the screen "too often", and "nobody bothers that such apps are for the needy ones."

Hence, while I decided to go to do it on the online portal, I opened the app on November 14 and the message now reads: "Recent data from similar devices show that this app may stop working on your device".

Strange, to say the least: Am using Samsung Galaxy A04e which has an Android version 14. If it can't be used on this, device which I bought a year ago, does the Government of India want 70 plus citizens, who have no regular income, to buy a more costly phone which is compatible with the app?

Be that as it may, after several tries online, which included getting OPT verified at least five times -- for mobile as well as for the aadhaar -- I succeeded in registering. It took me three hours to struggle through it, so complicated is the Aaushman portal. But finally I happily downloaded the card.

This prompted me to ask some other senior citizens to do it online instead of visiting the designated government office. A neighbour reached up to me with his 82 year old mother to help do it. So we got down to it. I registered her ditto as I did it for myself, and the final message said, "You can download the Aaushman card after some time."

Once you are registered, you must receive a message on mobile, but lo! No such message came. Even after aadhaar verification -- it took this grand old lady's each detail, including full name, age, even the aadhaar photo -- the message that she received said: You must upload your aadhaar card to the aadhaar portal https://uidai.gov.in/."

So there was no download. The neighbour decided to register the aadhaar on the Government of India's two apps -- Digilocker and Aadhaar app. He did this, we did the KYC again on the Aaushman portal, yet we were stuck: though the message in the end declared "Congratulations you can download the Aaushman card after some time", we couldn't go to the download link; instead there was a message on the portal stating Aadhaar couldn't be verified!

The grand old lady was taken to the government office next day morning in order to get the Ayushman card issued, as the online wasn't happening. On coming back, the dejected neighbour told me that the operator "tried out through different means for 15 minutes", but the Aadhaar was not getting verified! "Now I have been told to take her to a government health office to get the Aadhaar verified, only then Ayushman card would be made. This despite the fact that the Aadhaar had already been verified in Digilocker and Aadhaar apps, both Government of India's apps.

There is yet another confusion: the government office which does manual registration says in an unsigned chit pasted outside that Ayushman's total benefit would be up to Rs 10 lakh, though the portal said Rs 5 lakh. Let me clarify: Rs 10 is true for only those senior citizens who had registered themselves under the earlier Aayushman scheme which required an income and a lower age cap. As for other 70 plus citizens, it's Rs 5 lakh only.

Meanwhile, there is a huge flutter in Ahmedabad: two patients from Kadi town, about 20 km from Ahmedabad, died in a private hospital registered for Ayushman purpose after angioplasty was allegedly conducted without their consent. Both were the beneficiaries of the Aayushman scheme.

The entire incident reportedly came to light after the hospital organised a ‘free camp’ under PMJAY, even though "no such camps are allowed under PMJAY." An investigation has revealed that the hospital organised the camp without permission. The hospital's owner, CEO and the doctors who conducted the angioplasty "have gone underground."

According to the report, the hospital claimed about Rs 27.71 crore from the government for over 600 cardiology treatments. A total of 380 angiographies, 220 angioplasties and 36 coronary artery bypass grafting (CABG) surgeries were performed mostly under the earlier Ayushman scheme Between June 1 and 12; the hospital claimed funds for 650 cases from the Health Department.

The report further suspected political connection, stating, there were images on the social media of the hospital owner with the Gujarat health minister together. The owner in one image showed receiving an award from the minister in the presence of BJP bigwigs.

Searching for any criticism of the scheme, I found The Hindu daily saying in an editorial that while the move is welcome, especially considering that out-of-pocket expenditure for health care in India is "among the highest in the world." But there is a caveat: "it will in no way fulfil the public health objectives that are much needed for the targeted beneficiaries."

The editorial says, the scheme "is limited to secondary and tertiary care hospitalisation. The absence of coverage for outpatient care, diagnostics and medicines is particularly concerning as chronic diseases have increased sharply in India in the last few decades" with people over 70 very often suffering from these.

It continues, "Most of the health-care expenditure by the elderly will, therefore, be through outpatient care (40%-80%), which will not be covered by the scheme. Since its launch in 2018, the penetration of PMJAY into smaller cities and towns has been low in most States. Unlike in most of the southern States, primary and secondary health care in the public sector has been largely neglected..."

The editorial concludes, "Weakened primary and secondary health care will result in an overload in tertiary health care, which the private players will be well poised to take advantage of. This can lead to a further shrinking of the government’s commitment to strengthen the public health-care system by over-relying on the insurance modality..."

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