PMJAY Based on Failed Insurance Model: Activists

Health activist groups on Tuesday criticized the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), saying it is based on the discredited insurance model despite massive evidence against the effectiveness of such insurance-based schemes involving major participation of the private sector in delivery. In a statement issued by Jan Swasthya Abhiyan (JSA), a federation of civil society groups working on public health, they pointed out that the Rashtriya Swasthya Bima Yojana, which offered a cover of ₹30,000, had proved a failure and wondered why the cover was being raised to ₹5 lakh when past experience had shown that an overwhelming majority of claims under insurance schemes were in the region of ₹10,000- 50,000. Such a huge increase in the potential claim amount would not translate into a windfall for patients, the activists argued.

It also questioned the government’s claim that AB-PMJAY would be the largest health protection scheme in the world, pointing out that the ongoing National Health Mission with an annual outlay of ₹35,000 crore was much bigger given the ₹2000 crore allocated for the new scheme. “Further the scheme will only cover hospital-based care, while data shows that the bulk of expenditure that patients incur is on conditions when they are not admitted to hospitals – such as patients receiving care for TB, cancers, etc,” pointed out JSA. “The Niti Ayog claims that the AB-PMJAY will be 17 times bigger than the RSBY scheme but the moot question is: how can we expect the same government to effectively run a much larger scheme when it failed entirely in case of the RSBY scheme and several state level schemes?” asked JSA. More than just the failure of RSBY, JSA expressed concern over the quality of services provided under it and clear evidence that the scheme was being milked by unscrupulous private providers to profiteer, often through unnecessary procedures. – TOI