Ayushman Bharat: Cuts expenses, expands health care net, gives Centre imprint across states

From a political standpoint, Modi has underscored that the scheme is integral to building trust. While health is a state subject, this scheme has allowed him to make the Central government a key stakeholder in providing access to free healthcare to citizens across states, irrespective of which party is in power.

The study of the RTI data reveals this and more. Particularly, states in the south, ruled mostly by Opposition parties, which already had their own insurance schemes and relatively better healthcare infrastructure, have made the most of the Ayushman scheme.

In states like Bihar, Jharkhand, Madhya Pradesh, Maharashtra, and Uttar Pradesh, which had low health insurance coverage before the launch of Ayushman Bharat, the scheme has brought benefits to a significant portion of their population.

Data also shows its impact on cutting household expenditure on health. Out-of-pocket expenditure in 2014-15 was as high as 62.6 per cent of the total health expenditure for a household. In 2019-20, two years after the launch of the scheme, this dropped to 47 per cent of the total health expenditure. These are early signs and data of later years once available will shed more light on this trend.

This decline can be partly attributed to a substantial increase in social expenditure on health, encompassing government allocations for premiums or budgets designated for health insurance schemes like the PMJAY. Indeed, social security expenditure on health has risen to 9.3 per cent in 2019-20 from 5.7% in 2014-15.

And it is socio-economically disadvantaged groups that benefit the most.

A considerable portion of the scheme’s beneficiaries are from the scheduled castes, scheduled tribes, and other backward castes, which have to endure a disproportionate burden in terms of medical costs relative to their incomes. During hospital stays, for instance, the average medical expenditure per case of hospitalisation for rural SC individuals amounts to Rs 11,315, while their urban counterparts spend Rs 18,380. For STs, it is Rs 14,857 in rural areas and Rs 19,492 in urban centers, and for OBCs, Rs 16,114 in rural regions and Rs 21,778 in urban settings. Annual coverage of Rs 5 lakh provided by the scheme can, therefore, substantively mitigate their out-of-pocket expenditure.