Five years ago, India’s ruling Bharatiya Janata Party (BJP) made big promises with regard to health. Specifically, it promised a reduction in out-of-pocket spending.

Very few of these promises actually came to fruition, though. For instance, a pharmaceutical policy and a policy to curb Chinese imports from dominating the bulk drugs market were announced, but never actually enacted. The latter is especially interesting because in 2017, as The Ken reported, Indian pharma’s dependence on Chinese bulk drugs was flagged as a security concern by no less than the Prime Minister’s Office.

Meanwhile, a Bill that would check the quality of medical devices—drafted 12 years ago—never made it in front of Parliament for approval. The Bill could prevent a repeat of what happened between 2004-2010, when some 4,700 patients fell victim to faulty hip implants by pharma company Johnson & Johnson (J&J).

The government even talked up a uniform ethical code—one that penalised pharma companies for incentivising doctors to prescribe their brand. It was, however, never made mandatory. As The Ken had reported in November 2017, the uniform ethical code for pharma marketing practices (UCPMP) was announced but never implemented. This could have broken the unethical relationship between doctors and pharma companies. Could being the operative word.

E-pharmacies also remained stuck in legislative limbo. Legislation approving e-pharmacies has been in the works for about two years now, but still hasn’t been finalised. Meanwhile, e-pharmacies continue to battle offline chemists in courts.  Most recently, in an affidavit to the Delhi High Court in February, the Ministry of Health requested a six-month extension to legalise e-pharmacies.

And, if e-pharmacies remained in limbo, IHIP—the integrated health information platform—met its end altogether. Envisaged as a platform that could bring all hospitals under one system, it was meant to make healthcare accessible, affordable, transparent, and help insurers get better data to control hospital treatment prices. This was in January 2017. By mid-2018, IHIP was scrapped. In its place, the government opted for an even more ambitious scheme—Ayushman Bharat.

In fact, Ayushman Bharat, the world’s largest health insurance scheme, was one of two of this government’s healthcare initiatives that actually took flight. The second was the use of the Drug Price Control Order of 2013 to cap prices of essential drugs and devices. Ayushman Bharat, meanwhile, has controlled hospital treatment prices.

Both of these are good in principle. But there’s a problem. They are at odds with each other.

Ayushman Bharat is an insurance scheme that is predicated on large-scale insurance providing support to 100 million underprivileged families.