This is a guest blog by Manish.
The Union Cabinet chaired by Prime Minister Narendra Modi launched Ayushman Bharat -National Health Protection Scheme (AB-NHPS) on 21 March 2018.Recently it was launched in Jharkhand in Sep 2018, renamed as PM Jan Arogya Yojna(PMJAY). The scheme has been analyzed in this blog.
What is the Scheme?
The scheme is targeted at poor, deprived rural families and identified occupational
categories of urban families. So, if we were to go by the Socio-Economic Caste Census (SECC) 2011 data, 8.03 crore families in rural and 2.33 crore families in urban areas will be entitled to be covered under the scheme. It will cover around 50 crore people.
AB-NHPS will have a defined benefit cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. It will offer a benefit cover of Rs 5 lakh per family per year. It will subsume the existing Rashtriya Swasthya Bima Yojana(RSBY), launched in 2008 by the UPA government.
To ensure that nobody is left out (especially women, children and the elderly), there will be no cap on the family size and age under the AB-NHPS. The scheme will be cashless and paperless at public hospitals and empanelled private hospitals.
How Beneficiaries will be Identified?
Families were identified on the basis on Socio Economic Caste Census(SECC) 2011.
The different categories in rural areas include families:
- Having only one room with kucha walls and kucha roof,
- families having no adult member between the ages of 16 years and 59 years,
- female-headed households with no adult male member between the ages of 16 years and 59 years,
- disabled members and no able-bodied adult member in the family and
- SC/ST households and landless households deriving major part of their income from manual casual labour and.
- households without shelter, destitutes living on alms, manual scavenger families, primitive tribal groups, and legally released bonded labour.
For urban areas, 11 defined occupational categories are entitled under the scheme. Main source of income related to household has been clarified in urban areas as:
- domestic workers,
- street-vendors/cobblers/hawkers/other service providers working on the streets,
- construction workers/ plumbers/ masons/ labor/ painters/welders/ security guards/coolies and other head-load workers,
- sweepers/ sanitation workers/ gardeners,
- home-based workers/artisans/handicrafts workers/ tailors,
- transport workers/ drivers/conductors/helpers to drivers and conductors,
- cart pullers/ rickshaw pullers, shop workers/ assistants,
- peons in small establishments/ helpers/ delivery assistants attendants/ waiters,
- electricians/mechanics/ assemblers/repair workers, washer-men/ guards.
The beneficiaries will not be required to pay any charges and premium for the hospitalization expenses. The benefits include pre and post-hospitalization expenses.
Each empanelled hospital will have an ‘Ayushman Mitra’ to assist patients and will coordinate with the beneficiaries and the hospital. They will run a help desk, check documents to verify the eligibility, and enrolment to the scheme.
Also, all the beneficiaries will be given letters having QR codes which will be scanned and a demographic authentication will be conducted for identification and to verify his or her eligibility to avail the benefits of the scheme.
Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
At the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) would be put in place. States/ UTs would be advised to implement the scheme by a dedicated entity called State Health Agency (SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme. States/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.
In-patient hospitalization expenditure in India has increased nearly 300% during the last ten years (NSSO 2015). More than 80% of the expenditure is met by out of pocket (OOP). Rural households primarily depended on their ‘household income savings(68%) and on ‘borrowings’ (25%), the urban households relied much more on their income saving’ (75%) for financing expenditure on hospitalizations, and (18%) on borrowings (NSSO 2015). Out of pocket (OOP) expenditure in India is over 60% which leads to nearly 6 million families getting into poverty due to catastrophic health expenditures. AB-NHPM will have major impact on reduction of Out Of Pocket (OOP) expenditure on the following grounds:
- i) Increased benefit cover to nearly 40% of the population(the poorest & the vulnerable).
- ii) Covering almost all secondary and many tertiary hospitalizations (except a negative list).
iii) Coverage of Rs 5 lakh for each family (no restriction of family size).
This will lead to increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to. This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency and job creation, thus leading to improvement in the quality of life.
5 States Opted Out?
5 states, namely Delhi, Kerala, Odisha, Telangana & Punjab have opted out of the scheme. The major reasons are:
- The states have a better scheme.
- They mistrust the Central government (Delhi definitely has plenty of reasons for that!).
- Punjab has an issue with the 60:40 funding ratio.
Major Challenges in Implementation
- India has a paucity of doctors, hospitals and associated infrastructure to cater for the scheme. Public expenditure needs to drastically increase and private sector needs to expand fast to meet the requirement. A poor patient located far away from a hospital will neither know about this scheme or will be able to benefit from it.
- The amounts being offered for various procedures are not acceptable to the private sector health providers. For example, the proposed cost of a coronary artery bypass graft (CABG) is about ₹90,000. The Central Government Health Scheme (CGHS) rates for this in Delhi are above ₹1.1 lakh and private hospitals routinely charge above ₹3 lakh.
- The fund allocation in the Union Budget was Rs 2,000/- crore. Speaking to NDTV in August 2018, Dr Indu Bhushan, the CEO of Ayushman Bharat, said 6,000 to 8,000 crore will be required. Another figure of Rs 12,000/- crore( expecting a 6:4 share model) talked about in the current year is also apparently inadequate to meet the tall claims.
There is definitely a need for helping the poor with health care. The Public health system and funds allocation in the past as also the present government have been grossly inadequate.
Even if we ignore the propaganda methods of Modi in the election year the idea is laudable.
I am sure even Indu Bhushan would not know as to how effective the scheme will prove hence I am keeping my fingers crossed to watch the idea translate on ground with optimism.