Biju Swasthya Kalyan Yojana – A Bold Initiative But Susceptible To Hit Roadblocks

Odisha continues with a modest health infrastructure. With 2501 hospitals including 695 in private sector, the state provides only 25,650 hospital beds as against Kerala’s 3342 hospitals including 2062 private hospitals providing 99227 hospital beds— almost four times. Odisha’s hospitals have 1282 ICU Beds and 641 ventilators while Kerala provides 4961 ICU Beds and 2481 ventilators. While private sector is the dominant provider of hospital beds, ICU and ventilator facilities in Kerala, public sector is the dominant provider in Odisha. 

Most of India’s hospital bed and ventilators are concentrated in seven States - Uttar Pradesh (14.8%), Karnataka (13.8%), Maharashtra (12.2%), Tamil Nadu (8.1%), West Bengal (5.9%), Telangana (5.2%) and Kerala (5.2%). Private sector has dominant presence in India’s health facilities having more hospitals, more hospital beds, more ICUs and more ventilators than what the public sector hospitals have.

Since over 80% of Indians were without health insurance cover, high hospitalisation charges were paid by people out of their savings or borrowing. The Ayushman Bharat initiative of Government of India covering about 11 crore poor families of the country came as a great relief to the economically vulnerable people as hospitalization was made free for them up to a reasonable financial limit. Odisha Government, however, decided to launch its own scheme and crafted an Assurance scheme making about 99% of the state’s families eligible for cashless treatment facilities in empanelled private hospitals for some ailments.

Biju Swasthya Kalyan Yojana (BSKY) has been launched, as the state government says, as a “pathbreaking programme” to provide universal health coverage, with special emphasis on the health protection of economically vulnerable families. The goal is sought to be achieved through two components. First one is the State Government will bear full cost of all health services delivered to all patients (irrespective of income, status or residence) in all State Government health care facilities starting from sub-centre level to district headquarters and Government Medical College Hospital and Blood Bank level. Second, the State Government will bear the cost of healthcare provided in empanelled private hospitals for over 96.5 lakh economically vulnerable families in the State, amounting to Annual Health coverage of Rs 5 lakh per family and Rs 5 lakh for the women members of the family over and above the five-lakh limit.

Two areas in this scheme, however, need a closer look. The state’s population in 2021 is estimated at 46.8 million. The average size of a family in India is 4.8. On this basis, the state would have a total number of 97.5 lakh families. The state government has covered as many as 96.5 lakh families under the BSKY identifying them as economically vulnerable families. This leaves only one lakh families of the state who seem to be economically well off. This is a sad commentary on the quality of implementation of the poverty amelioration programmes of the state government for over two decades. The second area of concern is the policy to provide everyone free medical facility, medicines, in government health institutions. Here both the poor and the rich benefit. If this is the case, why then are hundreds of medicine shops functioning, why are there so many diagnostic centres, and what is the rquirement of so many private medical professionals in the state? Obviously, they are in business because they have customers. Private hospitals too remain overcrowded. This raises issues of credibility and quality of service. 

Official website mentions that since its inception on August 15, 2018, the BSKY has launched a new era in Universal Health Coverage, with over 45 lakh instances of cashless treatment being provided each month. The scheme is being operated by the State Health Assurance Society. As per the arrangement, the private hospitals are to submit claims within a month and the valid claims would be paid by the government within two months. Reports, however, have started appearing in the press about pending claims of private hospitals and about the cost of treatment fixed by the government being unrealistically low and unworkable. The scheme, it appears, has hit road-blocks soon after being in operation. It is apprehended that with the number of smart-card holders seeking treatment in empanelled hospitals increasing, timely payment of claims by the Assurance Society would pose real problem leading to disruption of cashless facility—a situation encountered by many beneficiaries of the Central Government Health Scheme (CGHS) in Odisha in respect of many empanelled hospitals in Bhubaneswar. 

To realise the Chief Minister’s faith that “every life is precious” the state must have adequate number of Doctors, Nurses, paramedical staff, adequate and functional equipment. The state however is acutely short of doctors; the infrastructure is just modest; cases of ambulance failing to reach waiting patients in time are many. These areas of concern warrant much greater attention. 

Chief Minister touring various districts for distribution of the smart cards for the BSKY immediately after the last Assembly session (which he did not attend) was adjourned much before the schedule makes many wonder if it’s intended to garner political dividends in the impending elections to the ULBs and PRIs. Many also feel that the reason for keeping the state away from the national scheme of Ayushman Bharat was to generate political support. But it needs to be appreciated that our system of government is a political arrangement and a party in power is well within its rights to shape policies that ensure both public good and beneficial for the party. In that sense the BSKY is a bold political initiative but a hugely expensive and challenging one. Today it looks highly susceptible to hitting road blocks. It will be a pity if it doesn’t succeed. For its success, the state needs a robust infrastructure which it now doesn’t have. 

(DISCLAIMER: This is an opinion piece. The views expressed are the author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same. The author can be reached at lonewalker.1942@gmail.com)

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