Karnataka to Withdraw From Ayushman Bharat

Government of Karnataka has decided to withdraw from the central government’s healthcare scheme Ayushman Bharat. Chief Minister H D Kumaraswamy, speaking to the press in Mysore, said that the government has decided to go back to the Yeshasvini Scheme.

Prajavani, a Kannada daily, quoted the CM as saying, “People from the state are in trouble because we had decided to dissolve the Yeshasvini scheme. The state government has reserved Rs 700 crore for Yeshasvini scheme and Arogyashree schemes. However, the central government had requested to club its Ayushman Bharat and Karnataka Arogyashree, and we had agreed to it. And now the central government’s share is just Rs 200 crore and our is Rs 800 crore. But the central government is going around taking credit for Ayushman Bharat, and by doing this, the BJP is misleading the people of Karnataka.”

This move and the statement by the CM bring into light the farce of Ayushman Bharat.

Also Read: Privatisation of Karnataka’s Health Sector: Karnataka to Sign an MoU With AB-NHPS

As experts Oommen C. Kurian and Rakesh Kumar Sinha write, “Karnataka is one of the first Indian states to put a state health policy in place (2004). It has also been a pioneer in government supported health insurance schemes, with Yeshasvini (2003) and Vajpayee Arogyasri (2010) among the first initiatives in India.”

The state has so far stuck to the insurance-based health schemes—from Yeshasvini Scheme to Arogya Karnatak to Ayushman Bharat, and now back again to the Yeshasvini Scheme. Ayushman Bharat, which is being lauded as the best of the schemes of the NDA, is not being well-received in the state. Even though interim Finance Minister Piyush Goyal, while presenting the interim budget, applauded the scheme, they have allocated a meagre amount of Rs. 6,400 crore for what is being called the “world’s largest health care programme”.

Karnataka is not the first state to face issues with the scheme. What is the use of any public health policy or scheme if privatisation is the goal of the government?

Yeshasvini-Arogya-Ayushman Bharat-Yeshasvini

Yeshasvini Scheme – launched by S M Krishna-led Congress government in 2003 – was particularly popular among the farmers. This scheme was one of the largest self-funded healthcare schemes in India. The scheme covered 823 surgical procedures and any person who was a member of a cooperative society was eligible for it.

Under the scheme, each beneficiary is required to pay Rs 300 (rural) and Rs 710 (urban) per year. As Pavitra C. Hampannavar and L. Manjunath of University of Agricultural Sciences, Dharwad writes, “The concept relied on a preliminary survey conducted among various public and private hospitals operating in Karnataka which revealed that occupancy rates remained everywhere as low as 35 per cent... Over the first two years, members paid Rs. 60 per year for each person insured. Third year the premium was set at Rs. 120. In 2014 it was(sic) at Rs. 210 per year, per individual. This was further increased in Year the fifth to include a marketing incentive (+Rs. 10) for co-operative societies. In addition, the Government of Karnataka provided each year a subsidy directly allocated to the premium, thus increasing the level of benefits to the members.”

Also Read: Ayushman Bharat Will Serve Private Insurance Coffers, Not The Poor

In March 2018, the former state government in Karnataka led by Siddaramaiah had launched Arogya Karnataka Yojane to ensure that primary, secondary and tertiary medication is accessible to each one in the state. Yeshaswini scheme, along with Vajpayee Arogyashree Scheme, Rajiv Arogya Bhagya Scheme, Rashtriya Swasthaya Bima Yojana (RSBY) including RSBY for senior citizens, Rashtriya Bala Swasthaya Karyakram (RBSK), Mukhyamantri Santwana Harish Scheme and Indira Suraksha Yojane, was subsumed into the Arogya Karnataka Yojane. This universal health coverage for residents of Karnataka excluded the residents who have purchased private health insurance policies on their own, and also those covered under Central Government Health Scheme of the Government of India.

The scheme aimed at providing a financial assistance up to Rs 30,000 per annum for specified complex secondary healthcare treatment to a family of up to five persons. In the event of the family requiring specified tertiary healthcare treatment, this annual limit would be increased to Rs.1.5 lakh per annum. For any family needing specified emergency tertiary healthcare treatment even after full utilisation of the annual limit, the additional assistance of Rs. 50,000 would be provided.

However, the state later signed an MOU with Ayushman Bharat-National Health Protection Scheme (AB-NHPS).

The Ayushman Bharat, launched in 2018 by the Centre, promised an insurance coverage of Rs 5 lakh per family to about 10 crore of the poorest families. The health insurance scheme aims to provide insurance for both the public and private hospitals. According to a report in the Business Line, on January 29, 2019, “The scheme’s budget has been slashed by at least Rs 800 crore. While the National Health Agency (NHA) — the implementation agency of Ayushman Bharat — had demanded Rs 7,400 crore to meet the expenditure for 2019-20, the Ministry of Finance initially agreed to allocate close to Rs 7,200 crore.”

Following insufficient funds, out of the allocated Rs 3,135 crore for 2018-19, only Rs 1,400 crore have been received. This delay in flow of funds, according to the Business Line report, has resulted in the state governments not receiving funds. Officials of NHA told the Business Line, “Till date, the Centre has released close to Rs 766 crore to States, but has not been able to pay the current additional liability of over Rs 1,700 crore.”

Just like Madhya Pradesh and Tamil Nadu, Karnataka has also not received sufficient funds under the scheme and thus, Karnataka has now decided to opt out of the scheme.

Also See: Ayushman Bharat Is Not the Answer to India’s Health Needs

Praneta Jha, arguing that the only beneficiaries of the Ayushman Bharat scheme are the private investment companies, writes, “Given the severe paucity of an adequate number of public-funded hospitals with the requisite facilities — as public hospitals are starved of funds while private players are given incentives to set up shop — the insured patients will largely go to private hospitals only.”

In its annual budget for the fiscal year of 2018-2019, the central government has allocated only Rs 52,800 crore for health, and it is just five per cent more than what was allocated in 2017-2018, which was Rs 50,079.6 crore.

Thus, low investment in the public health, launch of over-ambitious schemes like Ayushman Bharat, and the lackadaisical attitude regarding implementation prove that the healthcare scheme is just another jumla (bait) of the BJP government.

Government of Karnataka and Public Health

Even though CM Kumaraswamy has decided not to be part of the jumla of the central government, and has rightly accused the BJP for misleading people in the state by taking credit, and not contributing, his government has shown less interest in public health.

The state government, in 2017, strived towards amending the Karnataka Private Medical Establishments (KPME) Act, 2007, standing against the schemes supporting the private health sector. However, a cursory look at the allocations made for the sector now shows that the state's health sector is moving towards privatisation. The allocation for the health sector by the state government was slightly more – by 3.05 per cent – that the previous year’s allocation. The data shows the decline in state’s expenditure on health since 2001. For the year 2000-2001, the allocation in the state budget was 5.1 per cent higher than the all-state average expenditure on medical and public health, which was 4.6 per cent. One can see that the state’s allocation has usually been at par with the all-state average expenditure in the health sector. However, this has changed now. For the year 2016-2017, the all-state average expenditure was 4.9 percent and for the 2017-2018 the state allocated 3.5 percent.  

Also Read: Karnataka’s Expenditure on Education and Health is Shockingly Low