he National Health Protection Scheme (Pradhan Mantri Jan Arogya Yojana) was launched in September 2018 amidst euphoria. But closer look at the blueprint released by the National Health Agency reveals that the patient could actually suffer many hardships. What is more saddening is that in spite of several studies analysing already existing government health insurance schemes, the newly christened PMJAY doesn’t reflect the important lessons learnt.
This analysis focuses on three issues.
Identifying poor families
First, let’s take the proposed methods of identifying beneficiaries. The NHA has stated that there would not be any (pre)enrolment process and instead, eligible households would be identified using the Socio Economic Caste Census data of 2011 (SECC).
Government documents say that ‘family letters’ would be sent to each household in the list with a QR code which lists the family member’s names. The NHA’s strategy is oblivious to ground realities whereby the poor (especially the urban) keep migrating and may not possess a consistent address, mobile number or a ration card, as laid down in Guidelines for Additional Collection Drive.
If family structures have undergone changes, the onus is put on the household to get the list corrected by providing birth or marriage certificates – provided one of the existing household members has Aadhaar. For those in the informal sector, it is not clear how the scheme would verify eligibility for the multiple jobs and transient nature of unorganised work.
Other research studies of different government health insurance schemes, including the author’s doctoral research, have highlighted exclusions of the most vulnerable sections from these insurance schemes because of outdated lists and lack of documents.
And even among those who could be eligible, the NHA is looking for ways to exclude people. Recently, the NHA issued a circular whereby households which own a landline or a two wheeler or a refrigerator would get automatically excluded.
Second, Modicare takes pride in labelling itself as a paperless scheme, but not for the patient. The Arogyamitra stationed at every empaneled hospital will verify the identity of the ailing person, his/her relationship to the family and whether he/she is entitled to receive the benefit by verifying documents. It is after this step, that hospitals initiate the preauthorisation process.