Death and illness are inevitable. Immortality exists only in myths. We all have seen illness and death. And this is what Kisa Gotami realized when she looked for a handful of white mustard, desperately, from a household which had not seen death, ever. Lord Gautam Buddha had promised this unfortunate mother he would bring her only dead child back to life if she could procure the aforesaid. She failed, unfortunately, and in the process attained sainthood and became an Arhat/Arahant.
In India, illness visits a family with the dread of out-of-pocket expenses, compulsion to spend from meagre savings and incomes, and lack of quality and timely healthcare. It’s excruciatingly difficult to get treatment and appointments in government-run hospitals. These hospitals are woefully mismanaged and lack the basic infrastructure, at all levels. There is also a culture of insensitivity in these hospitals, the staff is neither trained nor motivated to serve with care and compassion. People lying on filthy pavements outside AIIMS, New Delhi, facing rain and heat, in the never-ending wait for treatment is a common sight.
Private hospitals are prohibitively expensive i.e., overpriced and out of reach for most of the citizens. In the greed to earn more and due to lack of regulation, these hospitals over-prescribe i.e., get unnecessary and expensive tests and procedures done. A week’s hospitalization in these hospitals could wreck the budget of a common family for years to come. The Covid pandemic showed us that a day’s treatment in such hospitals could easily cost Rs 1 lakh, which is close to the annual per capita net national income of this country which stood at Rs1,72,000 in 2022-23 as per the National Statistical Office (NSO). To find a way out, the educated middle class relies on private health insurance.
However, the poor neither have the awareness nor resources to take such policies. Hence, health insurance penetration of India is extremely low. To obviate this worrisome condition, the government of India came up with Ayushman BharatPradhan Mantri Jan Arogya Yojna (AB-PMJAY) scheme in 2018.
This scheme works at two levels. For primary level health care, it augments the set of government hospitals at block and district level. For secondary and tertiary level health care, like complicated heart and brain surgery, it provides insurance cover up to Rs.5 lakh per year, per family which roughly covers 40 per cent of the population, mainly covering the poor of the country. Recently, the government made citizens over the age of 70 years eligible for this insurance cover without any conditions such as poverty and backwardness.
However, AB-PMJAY is struggling on the ground. Most of the flourishing and big private hospitals do not accept PMJAY card holders for one reason or another. To resolve this situation, all hospitals in India must be brought under the PMJAY scheme. It must become a precondition to run a hospital in India. Despite the existence of ABPMJAY and insurance covers provided to citizens, particularly poor, by the state governments, at least 30 per cent of our population that is 40 crore citizens, live devoid of any financial protection for health as per a 2021 NITI Ayog report titled ‘Health Insurance for India’s Missing Middle’. The cover of PMJAY must be broadened to include all the citizens of the country, be they poor, middle class or rich.
Universal application of PMJAY i.e. covering all the citizens without any conditions will solve the aforesaid problem. Universal application of government-funded health insurance could help India to achieve universal healthcare, that is access of all citizens to quality healthcare. Critics would argue that it would drain the treasury. But what could be more important than health and treatment of citizens.
This budgetary pain is worth taking as it would secure the citizens and would provide them with safety cover in the event of illness and health emergencies. Unfortunately, universal healthcare is not an electoral issue. Somehow, most of the people do not vote for it. However, each of them is affected by the lack of it. It is the responsibility of the educated citizens of our country to initiate a constant discourse around the universal healthcare system and talk about it until it becomes a burning issue and is provided to each of us. The sooner, the better!
(The writer is a Delhi-based advocate.)