 Hello and welcome to NewsClick. Today we are going to talk about the Ayushman Bharat Health Insurance Scheme which was announced recently and to talk on the issue we have with us from people's health movement Dr. Amit Singh Gupta. Welcome to NewsClick, sir. So first of all this scheme, they are claiming, the government, Modi government is claiming that this is the largest health insurance scheme in the world. What do you think about that? How valid is that claim? Well, just by claiming that the scheme is the largest, it doesn't become largest. We have evidence of schemes outside India which are much larger, for example, in China. But that's not the point. If you see within our country, you have the national health mission, which was earlier the national rural health mission, which has been running for about a decade or more than a decade. And the annual expenditure on that is around 35,000 crores, 30 to 35,000 crores, which is the central allocation. And over and above that, each state also makes some allocation. Now, according to the Finance Ministry, the annual allocation for the Ayushman Bharat scheme will be 12,000 crores. But we don't know whether that allocation will ever be made, because in this budget, an allocation of only 2,000 crores has been made. So, how can it be claimed that a 2,000 crore or at best a 12,000 crore scheme is larger than an already functioning scheme, which consumes 3 to 4 to 5 times that money, which has been running for a decade? So, this is one part of the claims that are being made about the scheme. The second part is that this will change the public health sector, especially for the poor of this country. How valid do you think that point is? See, we need to understand what this scheme really aims to do. Now, this is not a new scheme in the sense that similar schemes have existed in the country from about the early 2000s. The first similar scheme was the Aurogyrshri scheme in Andhra Pradesh. And since then, there have been many state-level schemes that have been rolled out and the national-level scheme, which is called the RSBY scheme that has been rolled out. Now, all these schemes, we have to understand and underline, are only for hospital-based care, which means that outpatient care is not covered by this. And the actual treatment under the scheme is provided by a mix of private facilities and public facilities who are part of the empaneled list of facilities. Overwhelmingly, going by past experience, the empaneled facilities are private. So, essentially, it is a privately provided hospital-based care that is supported by public money, which means you are my money. Now, when we say that this will benefit the people who need it the most, you have to keep in mind the fact that there are districts in the country where in most of the areas, there are neither public nor private facilities. So, irrespective of whether somebody is designated as a beneficiary, if there are no facilities, then it is in that sense quite meaningless to actually have this scheme. And as I said earlier, it also leaves out a very large number of people who are spending from their pockets on outpatient care, sometimes for chronic diseases for months or even years or lifelong, who will not be covered by the scheme because they are not hospitalized. So, whether it is a cancer patient, TB patients, people of diabetes or various other chronic diseases. So, to believe that this will actually solve all the healthcare problems of the people is unrealistic and especially it will not address the healthcare problems of those who need it most, which is the poor and the poor who live in most distant areas, which are the most underserved areas. This scheme, sir, is an insurance-based scheme. And this model, insurance model, when it comes to health, it has been like there have been evidence that it is a failure. Could you tell us a little bit about it? So, we have had a decade and a half of experience within the country. And in fact, there is a lot of international experience of very similar kinds. And what we know is that in an insurance-based scheme where you have mixed treatment, the facilities that provide treatment can either be public or private. So, mixed provision. There is overwhelming presence of the private sector in provision as in India. Now, what we have seen in India is that a section of the private facilities have utilized the scheme to profiteer, not just make legitimate profit, but profiteer, and actually provide treatment that is not required, do procedures that are not required, do investigations that are not required just in order to get the insurance money, which actually acts as a burden on the insurance system itself. It then pushes up the premium that is required to be paid with the government pays. But more importantly, we have seen evidence of extreme forms of malpractice. So, for example, in Chhattisgarh, Bihar, Jharkhand, there have been reports of unnecessary hysterectomy operations, removal of the uterus. In some areas, the incidence of hysterectomy operations almost overnight increased by 50 times. And these procedures were being done even in girls as young as 22 to 23 year old. Clearly, these were operations that were being done, not because they were needed, but because the hospitals stood to gain out of unnecessary operations. So, this has been one big problem with the insurance-based scheme, especially in a situation when there is almost no regulation of the private sector. So, to believe that an unregulated private sector, which is empaneled, will provide rational care of good quality and would cost reasonably, is not borne out by the facts. So, that is one part of it. The other, as we were also discussing, is it leaves out a lot of people, majority of people who do not access hospital care. And the third is that, again, the experience has shown that enrollment rates have been low. And even when people are enrolled, they have limited knowledge about what they can actually claim. And as we were saying earlier that it means nothing, even if they are enrolled, if you do not have facilities existing, because this scheme will not build facilities. It is only going to make use of existing facilities. There is nothing in this scheme that will contribute to actually building facilities. And the big gap that we have in India is that facilities just do not exist outside the cities, outside the periphery of the cities, in most parts of rural India. So, what you would be expecting is they would have to come to the district towns, to the capital cities to get treatment. So, sir, according to you, what is the alternate to such schemes? So, this is not rocket science. We know from experience all over the world that these success stories of public health have all been success stories of systems that are largely or almost entirely public. So, if you look at, say, in Europe, if you look at France or the UK or Italy, they largely public, almost entirely public systems. Cuba is, of course, an example that you have. Nearer home, you have Sri Lanka. You have Thailand now. You have Malaysia. Sri Lanka, a very close neighbor, 90% of hospital beds are in the public sector. And it is not an accident that Sri Lanka in the region has by far the best figures in terms of infant mortality, child mortality, etc. Not just hospital care. There are many other things that Sri Lanka has done, but it just shows that a public system contributes to good health. So, what we would argue is that instead of spending public money in strengthening the private sector, which this insurance base scheme is planning to do, the 12,000 crores that the government may spend next year, we don't know, or what many experts say that actually if you want to cover the number of people, 50 crore people that is being projected, you would need at least 50,000 crores. So, if really the government is going to spend that much of money, it is much better spent in creating assets, in creating facilities, in training medical personnel. Today, 50% of doctors are trained in private colleges of dubious quality. We have a shortage, not just with specialists on one side, we have a shortage of health workers who are properly trained. We don't pay our health workers. We have Asha workers who work for 20 to 24 hours, 28 hours a week, and they are called volunteers. So, if really we want healthcare to be available to the majority of the Indian people, there is no shortcut. It has to involve public investment and creation of public assets. That's what we should be doing rather than working on a system that tries to subsidize and strengthen the private sector with public money. Thank you for sharing your views with us, sir. Thank you for watching NewsClick.