Under Ayushman Bharat, top treatments: cardiology, cancer, general surgery, orthopaedics

As far as specific procedures are concerned, the top five in terms of total expenditure over six years: are dialysis, angioplasty, single stent to unblock arteries, Caesarean deliveries and implants for fractured hip.

The data is significant, but not surprising, because these are areas where the poor have limited access to care. Treatment under Ayushman Bharat, which provides free health cover of up to Rs 5 lakh every year to a family, can be potentially life-saving or play a key role in improving the patient’s quality of life.

For example, in rural India, medical expenses, on an average, for cancer in a government hospital is Rs 23,905, and over three times in a private hospital at Rs 85,326. For a heart problem, treatment in a private hospital costs Rs 42,759, almost six times that in a government hospital.

Government estimates show that heart or cardiovascular diseases alone claim 28.1% lives in India, chronic respiratory illness 10%, cancer 8.3%, stroke 7.1%, and diabetes 3%; overall, such non-communicable diseases account for 63% of all deaths in India.

In its first part Saturday, The Indian Express investigation had revealed that 54 per cent of Ayushman beneficiaries or 2.95 crore people used the scheme to access private hospitals, and they spent Rs 48,778 crore or more than two-thirds of the total expenditure of Rs 72,817 crore. Further, it showed that just five southern states accounted for 53 per cent of all patients.

Cardiology, general medicine, surgery top list

An analysis of NHA data and the Ayushman dashboard sheds light on where the government’s healthcare spending linked to the scheme is directed.

The maximum money under the scheme — Rs 4,222 crore — is spent in cardiovascular or heart-related diseases, Rs 4,100 crore in general medicine, Rs 3,895 crore in general surgery, Rs 3,650 crore in orthopaedics, and Rs 2,611 crore in medical oncology.

Between 2018 and 2023, the analysis revealed that 10 states accounted for 80% of the total patients who accessed treatment under the scheme: Tamil Nadu, Karnataka, Kerala, Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Uttar Pradesh, Gujarat, Jharkhand, and Punjab. Six of these, including Chhattisgarh and excluding Karnataka, were ruled by non-BJP parties for a substantial part of 2018-2023.

Beyond this, specific procedures emerge as focal points of expenditure, showcasing where resources are most heavily invested.

Over the last six years, the top procedures where the government spent the most include hemodialysis for advanced kidney failure (Rs 2,500 crore), and percutaneous trans-luminal coronary angioplasty or PTCA with diagnostic angiogram (Rs 1,691 crore), a minimally invasive procedure crucial for opening narrowed or blocked heart arteries.

PTCA with single stent placement, a technique involving the insertion of a wire mesh tube to restore blood flow, also features prominently with the government spending Rs 936 crore over the last six years. Additionally, Caesarean delivery (Rs 482 crore) and fracture hip internal fixation (Rs 452 crore), stand out as key areas of government spending.

Cardiology in Karnataka, ophthalmology in Jharkhand

The data reveals another trend — that India is a complex healthcare landscape with diverse needs, with patients in different states or regions accessing distinct treatments or specialties under the flagship scheme.

SOUTH: In Tamil Nadu, the government incurred the highest expenditures on three key specialties: general surgery, paediatric medicine, and general medicine. As for procedures, alongside various packages, the maximum expenses were directed towards hemodialysis, COVID-19 tests, and treatments for animal bites.

In Karnataka, cardiology, cardio-thoracic and vascular surgery, and obstetrics and gynaecology emerged as the top specialties that saw significant government funding. Procedures such as PTCA with one or two drug-eluting stents, alongside Caesarean deliveries, dominated expenditure charts in the state.

In Kerala, cardiology, general medicine, and orthopaedics stood out as the specialties that received the most funding, while procedures such as PTCA, hemodialysis, and provision of PPE for COVID-19 cases constituted major expenses.

In Andhra Pradesh, orthopaedics took the lead in expenditure, followed closely by general medicine and general surgery. Top procedures included fracture hip treatments, hemodialysis, and management of fractures of long bones.

NORTH: In Uttar Pradesh, the highest expenditures were in general surgery, general medicine, and ophthalmology, with phacoemulsification with foldable hydrophobic acrylic or cataract surgery being the top procedure alongside PTCA and hemodialysis.

Meanwhile, in Madhya Pradesh, cardiology, general medicine and orthopaedics took precedence, with PTCA, hemodialysis, and Caesarean delivery ranking as top procedures.

In Chhattisgarh, the maximum expenditure was in obstetrics gynaecology, orthopaedics, and general surgery, with Caesarean delivery, normal delivery, and hemodialysis leading in medical procedures.

Jharkhand’s top specialties were ophthalmology, general surgery, and general medicine, with hemodialysis, cataract, and gallbladder stone removal being the top procedures.

Punjab incurred the most expenses in orthopaedics, general surgery, and cardiology, with PTCA, hemodialysis, and gallbladder stone removal procedures topping the charts.

WEST: In Gujarat, the biggest share of healthcare expenditure was directed towards three key specialties: urology, cardiology, and medical & radiation oncology. Among procedures, the highest expenditures were attributed to hemodialysis, cataract surgery, and primary total knee replacement surgeries.

The takeaways

The data illuminates five key trends that shed light not only on prevailing healthcare priorities but also carry substantial implications for public health on a broader scale.

• First, state-wise data reveals that each state has distinct healthcare needs and that a one-size-fits-all approach to access healthcare may not be effective.

• Second, despite variation among states, certain medical specialties — general medicine, cardiology, and general surgery — have consistently received high government funding indicating where the government needs to focus its priorities while addressing healthcare needs.

• Third, understanding these regional variations is crucial for policymakers to allocate resources effectively and address the diverse healthcare needs across the country.

• Fourth, the data indirectly points out the critical departments within tertiary care infrastructure that demand further strengthening, evident from the influx of patients seeking treatment in these specialties.

• Fifth, states lacking key specialties and related treatments among their top services indicate a relative deficiency in these facilities compared to other regions. For instance, in 2012, Chhattisgarh saw 13,61,293 patients attending NCD clinics (non-communicable disease) under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS). Among them, a significant 31,690 patients were diagnosed with cancer, the highest nationwide.

However, according to Ayushman Bharat data, medical oncology ranked seventh in terms of treatment expenditure and ninth in terms of the number of patients treated, highlighting the urgent need for enhanced screening and cancer treatment facilities in the region.

Likewise, in Jharkhand, nearly a quarter of the six lakh patients visiting the NCD clinic were diagnosed with non-communicable diseases such as diabetes, hypertension, stroke, and cardiovascular diseases. However, Ayushman Bharat data reveals that cardiology ranks eighth in terms of treatment expenditure and doesn’t even feature in the top ten for the number of patients treated. This underscores the pressing need for strengthening cardiology services due to the high prevalence of these diseases.