Ayushman Bharat Scheme A Lifeline For Kashmir, GOI Should Work On Challenges And Gaps
In January 2025, when 62-year-old Mohammed Shaban Reshi of Kupwara suffered a severe stroke, he had to be rushed to Sher-i-Kashmir Institute of Medical Sciences in Kashmir. Over the next two months, Reshi underwent a complex neurosurgical procedure and hadto remain in the neuro intensive care unit of the medical institute for further treatment. Reshi, who comes from an economically disadvantaged family and is now recuperating after successful treatment and surgical procedures, recounts how he was able to afford it only due to the Ayushman Bharat Scheme.
“The scheme was of great help during the course of my treatment,” he says. With free medicines and essential medical supplies readily available at the hospital, he was able to secure support that he once deemed impossible.
Reshi is one among the many who have greatly benefited from the scheme that has revolutionized the healthcare system in India. It serves as an anchor, providing stability against the financial stress associated with expensive treatments.
Easing Financial Burden
Launched in 2018, Ayushman Bharat Jan Arogya Scheme (commonly known as the Golden Card Scheme) is a flagship healthcare initiative of the Indian Government. The scheme provides ₹5 lakh annually per family for secondary and tertiary healthcare across India.
This scheme is particularly essential for the Kashmir region, where approximately 25.67% of people live below the poverty line, rendering them significantly vulnerable to financial strain during treatment.
One prominent feature of the scheme is its cashless service at empaneled hospitals, significantly reducing out-of-pocket expenses. Often, these expenses hinder timely treatment as individuals struggle to arrange funds. The scheme’s cashless service helps expedite the treatment process. By easing financial burdens, the scheme allows patients and their families to focus on treatment rather than medical expenses, reducing anxiety and stress.
The out-of-pocket expenses often create a financial burden on patients and their families to arrange funds to meet medical expenses, which creates a precarious cycle of dependency and vulnerability as individuals attempt to manage their healthcare costs. But with the scheme, the beneficiaries can access treatment without the stress of immediate financial expenses. “I no longer have to worry about arranging money for medicines that are otherwise very expensive and beyond my budget. Thanks to the government, I can access medicines easily without stress,” says a family member of a neuro ICU patient.
Within The Tenets Of Religion
Kashmir, being a predominantly Muslim society, discourages participation in insurance schemes. A significant number of individuals believe that taking insurance violates their religious principles, thus depriving them of crucial safety nets during times of need.
It is crucial to conduct a comprehensive review of the treatment packages covered under the scheme, with a view to increasing the financial cap and incorporating additional provisions
In this context, Ayushman Bharat Scheme serves as an alternative, which can be availed without the fear of premium payments and aligns more with Kashmiri society’s values and religious obligations. It is a state-funded scheme that offers commendable health services without facing the nuances linked with the traditional insurance schemes. The scheme operates on the foundation principles of inclusivity and social welfare guaranteeing access to healthcare services to the most disadvantaged groups, without having to worry about exorbitantly high expenses.
Challenges And Gaps
While the scheme offers numerous advantages, several obstacles still hinder its complete effectiveness. According to firsthand accounts from Kashmir’s leading tertiary care hospital, numerous persistent challenges have been highlighted.
Many attendants reported frustration over lengthy queues, which delay the distribution of essential medications. For patients requiring urgent medical supplies, these delays can prove to be detrimental. In many cases, critically ill patients require immediate access to essential medicines. However, due to lengthy wait times and bureaucratic inefficiencies, attendants are often forced to purchase these items out of pocket to expedite the treatment process. The reliance on out-of-pocket expenses defeats the very purpose of the scheme.
Another major stumbling block is that numerous hospitals have only a single Ayushman Bharat facilitation centre operational. This results in delays, extensive waiting times, and frustration among attendants who are already exhausted from emotional and physical demands of caring for their loved ones.
An attendee at the neuro intensive care unit ward recalls: “Often, it takes several hours to procure medicines and other necessary resources from the centre. When doctors request a change in medications due to changing clinical status of the patient, we are often required to restart the entire process. This situation imposes significant stress on both the patient and the attendant. Moreover, many patients have attendants who are not well versed in the intricacies of the scheme. It is imperative that dedicated personnel be dispatched to the ICU to assist the patients, rather than expecting the patients or their attendants to seek help. While the scheme has provided substantial benefits, it is crucial for the government to focus on improving its accessibility and ease of use.”
Drugs Removed, Packages Insufficient
Since the implementation of the scheme, an ample number of drugs have been removed from hospital supplies. Under normal circumstances, such adjustments would not be a cause of concern. However, among the removed drugs are essential life saving medications. In critical situations, delay in administering these drugs can cause further complications, leading to increased morbidity and mortality. This situation can put patients at risk and also places immense pressure on the healthcare professionals who have to manage the situation with limited resources.
A major concern was regarding the packages of several treatments as they are deemed to be insufficient. The financial cap often proves to be inadequate forcing the patients to use their own funds to pay for the remainder of the treatment. This financial burden disproportionately impacts those from lower socioeconomic backgrounds, who are already struggling to make ends meet.
An attendant recalls: “My father underwent a major surgical procedure, but the predetermined coverage package of ₹1 lakh was insufficient, as the total surgery cost approximately ₹2 lakh. The hospital administration was unable to extend the coverage beyond the fixed package amount, leaving us responsible for managing the remaining expenses independently.”
Many individuals hesitate to apply for the Ayushman Bharat Golden Card, as they view the administrative procedures as cumbersome and only deem it essential during medical emergencies. Consequently, numerous families are compelled to cover the initial expenses themselves until the card application is approved and activated. This highlights the need to increase awareness and understanding of the scheme for its full potential to be realized.
Adding to these concerns, the government’s recent decision to eliminate four essential surgeries — cholecystectomy, haemorrhoidectomy, sphincterotomy, and appendectomy — from the scheme’s coverage list has sparked apprehensions. These surgical procedures are some of the most performed interventions under the Golden Card Scheme, so this decision poses a considerable impact on patients relying on this coverage.
THE WAY AHEAD
To address the identified barriers, there needs to be an urgent review of the scheme. Firstly, it is pertinent to augment the number of Ayushman centres at various medical facilities to refine the system, reduce wait times, and enhance accessibility. It is crucial to conduct a comprehensive review of the treatment packages covered under the scheme, with a view to increasing the financial cap and incorporating additional provisions. This would help ensure the scheme’s financial coverage is adequate and aligned with the needs of the target population, particularly those from lower socioeconomic backgrounds who are disproportionately impacted by the current limitations. Finally, implementing training programmes can further enhance the efficiency of the process.
Healthcare at its core is a fundamental right of every human being. It must not be relegated to being a privilege. In today’s world, even healthcare has not escaped the impact of capitalism, especially in private setups where the prices are kept exorbitantly high, neglecting the situation of the underprivileged. Often, governmental schemes do not operate within the private healthcare institutions making it hard for the economically disadvantaged to access them. Care and capitalism remain fundamentally contradictory — capitalism rests on exploitation and exclusion and care rests on universal access and equity.
For Ayushman Bharat to truly become a foundational scheme, improvements become essential. Trained professionals and expansion of hospital participation are much needed. Ultimately, Ayushman Bharat Scheme has provided a much-needed safety net that prioritizes healthcare against profit.
(Aayat Syed completed her Bachelor’s degree in political science and history from Delhi University. She is pursuing Masters in politics and governance at Central University of Kashmir. She can be reached at aayatgurcoo@gmail.com)
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