Ayushman bharat is a scheme which seems very altruistic ostensibly but has not proven to be cost effective . The people who should really be under ambit of the scheme are out. Good number of beneficiaries are actually above poverty line who evade exit from the scheme due to obvious political reasons. 80%of sweepers working in my hospital donot have AB as their papers are not proper. People who come in Bolero and scorpios flaunt AB cards. They are the vote feeders for the parties. AB for govt institutions is like अंधा बांटे रेवड़ी फिर आपन को देय । what is the need for them? They are already govt funded. The question is why private practice, small and medium hospitals flourished in last 20 years? 

 Because-

1. The people became quality conscious? 

2.The services in govt hospitals continued to deteriorate? 

3.The financial status of public in general improved as their purchasing capacity went up? Those who used hand waved fans in their houses have now installed ACs.

It was mostly middle class which switched from govt to private. This the class which is inherently thrifty and saving saavy in nature.This class joined the rat race of show off but they spend and lament about it. The private sector provided better services to this class but with a cost, hence it got soon maligned as greedy, and doctors as fleecers. The people didn't want to go to govt hospitals, but had to spend in private with a heavy heart. People selected their private service providers as their grocery shops according to their pockets but always looked upon them with suspicion. Its seemed a forced conversion though. People take pride in purchasing costly vehicles (one of the reasons Nano car failed), they take pride in arranging fat, hefty wedding ceremonies , but any expenditure on health issues comes as a great curse. OK this is general mentality I am not blaming but simply alluding to.

Now about AB scheme -

Its a unilateral scheme which seems to have been designed by non clinicians, without including the stake holders. Most of the HBPs are poorly designed and poorly priced too.

Package treatment always leads to price cutting and delivery of poor quality of service. It affects the treatment decisions and fetters the clinical decisions to limit within the package cost, which ultimately reflects on the treatment outcomes. There are a number of examples but just take haemodialysis here. The initiation of dialysis requires vascular access. The whole thing on cost to cost basis needs at least 5 to6 thousand rupees but you get 1485 /_without 33%income tax deduction. Will a hospital spend from its own pocket? Costly antibiotics meropenem and albumin are added in new packages recently but surprizingly for the treatment of respiratory failure and sepsis only.not for Nephrotic syndrome and chronic liver disease where they are needed the most .Blood transfusions are not attached to dialysis packages !!! Surprising There is so much incongruence and disparity in packages. On top of it claim rejection after initial CPD approval is a big shock to private player. They feel cheated. Poor packages and unpredictable claim disbursal leads to corruption at all levels and it is decaying the whole scheme. The payments are also delayed even for months to years. So cost cutting , poorly designed packages, unpredictable, non transparent claim approval and rejection processes added to delayed payments is a big deterrent for quality private hospitals to adopt this scheme. The musroomed small nursing homes run by politicians, builders, contractors, property dealers are happy dealing in AB pts as they have a knack of recovering money from govt through their devious corrupt ways. The honest hospitals mostly run by qualified doctors always languish. The scheme has proven as panacea for dying private medical colleges, who required to treat pts free, but now getting money as reward from AB. 

I can write a whole book on scheme but would limit myself here. On the flipside there are a number of good things delivered through the scheme too. But however altruistic the scheme be, from the point of view of the planners and politicians, it certainly needs a reappraisal, and a revamp. The stakeholders, field specialists, private docs should also be a party in designing the rates, patterns and structure of health benefit packages.