NEW DELHI: Underlining the poor public health infrastructure particularly in small towns and rural areas, a majority of the beneficiaries covered under the government’s ambitious Ayushman Bharat scheme availed of hospitalisation benefits in private hospitals rather than in government facilities.
Till March 24 this year, the total number of admissions under the scheme in private hospitals was 74.91 lakh while it was only 62.96 lakh in public hospitals, according to a reply received this newspaper under Right to Information Act.
The RTI reply also revealed that of the total Rs 17,934 crore spent by the government till March 24 this year towards coverage of the beneficiaries, Rs 11,611 crore worth of hospital admissions were in private hospitals and Rs 6,323 crore in the government sector.
The average expenditure per admission in a private hospital was Rs 15,500 while in a public hospital it was Rs 10,042.
The RTI reply said 14.66 crore health cards were issued till March 24 and a total 172.48 lakh hospital admissions were authorised.
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana was launched on September 23, 2018. It provides health insurance of up to Rs 5 lakh per family per year to poor households for secondary and tertiary healthcare hospitalisation.
Those covered under the scheme are mainly manual scavenger families, primitive tribal groups, domestic workers, street vendors, cobblers and hawkers, among others.
Hospital admissions in private facilities as compared to public sector institutions are not uniform among the states.
The RTI information reveals that in some states such as Uttar Pradesh, Maharashtra, Chhattisgarh, Jharkhand, Haryana, Tamil Nadu and Andhra Pradesh, admissions in private hospitals were 300- 400% more than in public healthcare facilities.
In UP, there were 5,19,388 private hospital admissions but only 1,50,282 admissions were in public health facilities.
Similarly in Maharashtra, there were 3,14,419 private hospital admissions in comparison with 89,026 public hospital admissions.
In sharp contrast to these two states, in Kerala public healthcare facilities have played a dominant role in admissions under the scheme.
The state recorded 5,75,872 admissions in private hospitals whereas there 14,14,712 admissions in public hospitals.
Karnataka also showed a similar trend with 2,38,793 private hospital admissions and 10,78,237 public hospital admissions under the scheme. Many northeastern states, including Assam, Tripura and Meghalaya also showed a similar trend.
Public hospitals lack healthcare infrastructure
Experts blamed the poor state of public healthcare infrastructure for fewer admissions.
Chandrakant Lahariya, a public health and policy expert, said people don’t prefer government hospitals because either these are not available or they are not providing competitive services, resulting in government money going to the private sector.
“The government is purchasing the services from the private sector in the short term. But, there doesn’t appear any intention or desire to strengthen public sector healthcare facilities for such a process. In the long run, there’s a lot of demand for health services which are not available,” he said.
Former union health secretary K Sujatha Rao blamed the poor condition of public health facilities.
“Once you take out the financial barrier where you don’t have to pay, would you rather go and stand in queues at AIIMs or will you go to Apollo? Obviously, you will go to Apollo which is cleaner and easier. that is the reason.”
The National Health Authority, the authority that implements the Ayushman Bharat scheme, said: “One of the objectives of the scheme is to provide beneficiaries with the option to avail quality healthcare services across both public and hitherto inaccessible private healthcare providers. It is up to the individual beneficiary as to where he/she would prefer healthcare treatment.”