National Healthcare Protection Scheme is better known as Ayushman Bharat.
What Is It About?
Ayushman, a phrase often used to bless someone with long life essentially recognises the message it carries. The government looks at providing healthcare benefits to more than ten crore families belonging to the poor and vulnerable economic strata. Fifty crore beneficiaries approximately will be provided with a cover for five lakh rupees per family per year for secondary and tertiary care hospitalisation. This mission will become functional under the on-going centrally sponsored schemes- the Senior Citizen Health Insurance Scheme (SCHIS) and Rashtriya Swasthya Bima Yojana.
Key Features Of The AYUSHMAN BHARAT Scheme
- The scheme is set to provide healthcare coverage of five lakh rupees per family per annum for availing secondary and tertiary healthcare facilities.
- The beneficiaries will get automatic coverage. Their eligibility is subject to the health insurance scheme and based on the Socio-Economic Caste Census (SECC) database.
- It features cashless hospitalisation for beneficiaries of the scheme in government or empanelled private hospitals throughout the countries.
- In contrast to the existing health insurance or medical insurance policies which have a waiting period in case of pre-existing diseases, the Ayushman Bharat Policy takes into account all sorts of diseases from day one. The benefit also covers the pre and post hospitalisation expenses.
- An Aadhar card is not yet made mandatory to avail the Ayushman Bharat benefit but carrying a prescribed ID is essential to receive free treatment from the hospital.
- The scheme is funded by both the centre and the state governments at a 60:40 ratio. This also indicates a future merging of the scheme with other existing schemes of the state government.
- The scheme once rolled out will be implemented by an insurance company or a trust or a society to ease the accessibility of the beneficiaries.
Who All Are Eligible
The eligibility criteria of the Ayushman Bharat scheme is widely divided into the urban and rural regions of the dwelling.
In rural dwellings, the following are to be looked at apart from the SECC database,
- Families living in one-room houses with “kuchha” walls and roof.
- Families with no adult members between 16 to 59 years of age.
- Families with a female head and no adult male between 16 to 59 years of age.
- Families with at least one disabled member and no able-bodied adult member.
- Households belonging to Scheduled Castes and Scheduled Tribes.
- Landless Households with their major income derived from casual manual labour.
- Destitutes and those surviving on alms of others.
- Primitive tribal groups.
- Manual Scavenger families.
- Legally released bonded labours.
In urban areas, the eligibility criteria are vastly different and consist of a list of eleven occupational categories of workers. They are:
- Rag Pickers
- Domestic workers
- Street vendors, cobblers, hawkers and other providers of service on the streets
- Construction workers, plumbers, masons, labours, painters, welders, security guards, coolies or porters and other head-load workers.
- Sweepers, sanitation worker and gardeners.
- Transport workers, drivers, conductors, helpers to driver and conductors, cart puller or rickshaw pullers.
- Shop worker, their assistants or peons in small establishments, helper, delivery assistant, attendants, waiters.
- Electrician, mechanic, assembler, a repair worker
- Watcher man or chowkidar
How Will AYUSHMAN BHARAT Affect India’s Healthcare Scenario?
The data generated during the implementation will help in designing future health care programmes with a better target.
The flip-side includes the Health and Wellness Centres (HCWs) which remains aloof from the media coverage. The primary health centres and health sub-centres of the country are presently limited to elements of maternal and child care and a couple of major infectious diseases. The HWCs are envisioned to broaden the domain of these centres and provide care for other chronic illness and infections.
With that comes the challenges:
- Each HWC would require a minimum allocation of Rs. 20 lakhs per annum, which would prove to be great value for money.
- The other aspect is that of a human resource policy that trains and recruits a salaried workforce of supplementary health workers per HWC, ensuring they are available when they are needed.
- The secondary and tertiary hospitals would need specialists and doctors coordinating and referring amongst themselves for the best outcome.
We are yet to obtain commitments in these regards.
Will It Extend To A Larger Public Benefit?
The major limitation of the scheme is the absence of any preventive or outpatient care.
The National Health Protection Scheme (NHPS), now known as Modicare lacks adequate funding and overlaps with several existing schemes of the State health insurance. Initially amount of Rs. 2,000 crore being allocated to cater 50 crore households is pathetically meagre, as each person each year would be entitled to Rs. 40 only. Even the Rs. 11,000 crores later projected is less than half of the minimum amount required for the scheme.
Thus we can effectively conclude that the NHPS is a publicly-funded health insurance programme within a limited budget. It aims to protect the poor from the secondary and tertiary healthcare costs which are NOT a novel design. Several such insurances already exist in States. Besides the need of care providers and hospitals in several regions is primary which requires public investment. In the private sector, a need for regulation is needed to determine the importance of health care needs of the underprivileged. Alternatively, the NHPS could have designed a more flexible route to finance tertiary care from public hospitals as well as less commercially oriented niches of the private sector to fill the existing insurance gaps. It could finance the already existing insurance programmes of the states instead of offering a frugal replacement. In this scenario it could have made an effective contribution in the states where there was not an already existing scheme, having learnt from experience.
The NHPS could have instead offered to supplement the existing public hospitals and healthcare facilities, which could benefit India’s healthcare scenario without enabling the corporate sector any more profit.