Healthcare tug-of-war: States vs. Center in India

In India's federal structure, health is a state subject. This means state governments are primary providers of healthcare services. But GoI also plays a crucial role in policy design and financing. This shared responsibility often leads to conflicts with states, intensified by political turf wars. Earlier this week, the PM highlighted this issue, stating that the 'walls of the political profession' are preventing the elderly in Delhi and West Bengal from benefiting from Ayushman Bharat.

Importance of any state-supported health scheme can't be overstated. About 63 mn people fall below the poverty line each year due to out-of-pocket (OOP) healthcare expenditure. Playing politics with such support structures does little to help. Delhi still can boast of a decent health support structure, but Bengal's system, as the recent RG Kar episode shows, is in tatters. Opposition-led states need not always obstruct for the sake of obstructing. Data from Tamil Nadu, Karnataka, Kerala, Jharkhand, Punjab, Telangana and Himachal Pradesh show that the scheme is providing relief for families struggling with specialised treatments, especially for life-threatening conditions.

While states should find ways to best use the scheme and avoid politicising health, Ayushman Bharat does have its share of shortcomings: limited empanelled hospitals, low coverage (only 56% of the eligible population covered), varying level usage across states, continuing high OOP expenses, ground-level corruption, private hospitals' reluctance to fully participate in delivering the full suite of services, and data mismatch. These holes need urgent fixing. This can only happen if GoI and states work together to keep the proverbial baby healthy while throwing away the bathwater.