Despite the abundance of health insurance options, public health remains the primary responsibility of the government. To facilitate better health outcomes for the public, state governments are coming up with insurance plans. The discussion around public health insurance also intensified after the spread of COVID-19.
About 15 years ago, the Andhra Pradesh government also joined the list of Indian states taking this initiative. The Aarogyasri initiative by the Andhra Pradesh government was among the early public health insurance schemes in India. However, there is a looming question regarding the performance of the scheme.
History of the Aarogyasri scheme
The Aarogyasri scheme came into existence in 2007. Introduced by the Congress government under the leadership of YS Rajasekhar Reddy, the scheme was first called the Rajiv Aarogyasri scheme. Over the past 1.5 decades, the scheme was renamed twice by the ruling parties and finally came to be called the DR YSR Aarogyasri scheme.
Shortcomings of the DR YSR Aarogyasri scheme
While the scheme has received appreciation for some of its features and advantages, such as secondary and tertiary care, it also has significant flaws.
- Distance restriction for primary care: A distance restriction on primary care states that the distance between the primary care centre and the patient’s home should not be more than 1 km. This requires the availability of MBBS doctors and basic infrastructure at all the sub-centres and wellness centres.
- Lack of funds available with hospitals: The government has started building health hubs that will have 50% of the beds reserved for Aarogyasri beneficiaries. However, critics say that since profit is the primary objective of these health hubs, they would focus on only secondary and tertiary services.
This has been confirmed by multiple patients and their relatives who were asked to pay for medicines, devices, or consumables because of the inability of hospitals to bear the costs.
- Non-payment of salaries: The Andhra Pradesh government hired 17,315 doctors and 18,763 staff members on a contractual basis in 2020 and 2021, and over 3000 were utilised for COVID-19 duties. Many of these complained about non-payment of salaries for a long time. This led them to not report to work.
- Improper implementation of the scheme in government hospitals: The scheme tried to offer incentives to specialist doctors by offering them a portion of the procedure cost. Funds were also allocated to hospital development. However, professionals believe these incentives cannot compensate for the lack of basic infrastructure and the shortage of nursing and para-medical staff. Many hospitals also reported that they lacked equipment for cardiac care.
- Expansion of the beneficiary base without improving the infrastructure: The income limit of the Aarogyasri scheme was increased to 5 lakhs, and the cards were also distributed liberally. This has brought over 96% of the population under the list of beneficiaries. However, the absence of permanent infrastructure makes it difficult to support such a huge beneficiary base.
- Non-payment to hospitals: Many hospitals have reported non-payment of dues by the government. They have also expressed concern that charges were not updated since the beginning of the scheme. This makes it difficult for them to offer care to the patients, and the patients bear the brunt.
The introduction of the Ayushman Bharat scheme: The Pradhan Mantri Jan Aarogya Yojana, which is a scheme sponsored by the central government, is now being implemented in the state. The national health agency and the state government are working together toward the implementation. The central and the state governments will share the expenses in a 60:40 ratio.
Summing Up
While the Andhra Pradesh government superseded other states in terms of fund allocation to healthcare, the DR YSR Aarogyasri scheme was poorly planned and executed. It failed to pay the healthcare professionals their dues. Even after the UGC pay scales were revised in 2016, the doctors weren’t remunerated accordingly until 2021. Even in 2021, they weren’t paid the arrears. This also affected the pension income of doctors that retired before March 1, 2021. These gaps made it difficult for the hospitals and governments to retain specialists, and thus, despite the Aarogyasri scheme, the system grappled with the shortage of doctors to treat the patients.
In all, the scheme was well-intended but failed to achieve its objectives because it overlooked primary concerns, such as infrastructural shortcomings and employee remuneration.