Editorial: Sickening revelations
Irregularities in the Ayushman Bharat fly in the face of govt’s boastful claims about its fight against corruption
The glaring flaws and irregularities in the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the mega national health insurance scheme, must serve as a wake-up call for the NDA government which is never tired of boasting about the project. A performance audit of the Centre’s flagship programme, launched by Prime Minister Narendra Modi in 2018 amidst much fanfare, has revealed shocking details about the deficiencies in its implementation. It turns out that the project, ostensibly aimed at benefiting over 10 crore people with Rs 5 lakh insurance cover per family per year, is riddled with corruption. The Comptroller and Auditor General of India (CAG) has detected serious flaws: dummy numbers, Aadhaar irregularities and treatment for dead patients. As per the CAG report, tabled in Parliament recently, over Rs 6.97 crore was paid for the treatment of 3,446 patients who had earlier been shown as deceased in the AB-PMJAY database. No less shocking is the fact that around 7.5 lakh beneficiaries under the scheme were linked to one single mobile number and a total of 1,285 beneficiaries were linked to one particular Aadhaar number. The NHA’s National Anti-Fraud Unit is tasked with the detection, deterrence and prevention of fraud and abuse under the AB-PMJAY, but its efficacy is under a cloud in view of the audit findings. After the damning report was tabled, the government informed the MPs that 210 hospitals had been de-empanelled and the licences of 188 others suspended due to their involvement in irregularities.
Though Ayushman Bharat is ambitious in its intent and scale, there are several challenges in its implementation. Foremost among them are the problems in dovetailing the State-level schemes already under implementation and the uncertainty over rates that insurance companies would pay hospitals for the procedures covered under the scheme. The lack of uniformity in hospital procedures and protocols for doctors is another major challenge. India spends only 1.25% of its GDP on healthcare, which makes it one of the most under-performing public health ecosystems. Though there has been an increase in the number of lives covered under public health schemes, the overall penetration is still low. More than 80% of the population does not have any significant health coverage. Despite the government’s boastful claims about its fight against corruption, it is clear that fake or ineligible beneficiaries are undermining this premier welfare scheme. The CAG assessment covered the period from September 2018 to March 2021 — part of which coincides with the Covid pandemic. There is an urgent need for an in-depth investigation to unearth the nexus between hospital staffers, middlemen and officials. Loopholes must be plugged on priority, failing which the anti-corruption fight would suffer a big jolt. As per the NHA database, over 24.42 crore beneficiaries have been registered for the scheme till date and Rs 67,456 crore has been spent on their hospital admissions.
