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Govt kicks off groundwork for Ayushman Bharat, to cover 1,347 treatments
The health ministry has held a series of consultations with the state governments and insurance companies to discuss the implementation of the scheme.
The central government has begun work on rolling out its ambitious healthcare scheme, Ayushman Bharat, day after the Union Cabinet gave its approval for the launch of the insurance project that aims to fund hospitalisation cost of an estimated 10 crore economically deprived families.
Union health minister Jagat Prakash Nadda on Thursday said the government has set June-end as the target for on-ground assessment of the information technology (IT) system, which he described as the “backbone” of the “totally cashless and paperless” National Health Protection Scheme (NHPS).
The minister said the Rs 10,000 crore scheme, which will provide a cover of Rs 5 lakh per family per year, will include protection for 1,347 diseases, with the possibility for addition to or deletion from this ‘package list of diseases’.
“The insurance scheme will take care of secondary and tertiary treatment, including treatment for cancer, cardiac and neuro surgeries. It will do away with out-of-pocket expenditure as comprehensive packages covering expenditure incurred in travelling to and from hospital are also being drafted. Patients will pay absolutely nothing from their pockets,” Nadda said.
Under the first phase of implementation, organ transplantation surgeries will not be included. “We are still fine-tuning the list. It will take some time,” said Preeti Sudan, secretary, health ministry.
The NHPS is a cashless scheme that can be availed at any government or private empanelled hospital across the country. “It (the scheme) is not linked to Aadhaar and no eligible person will be denied the benefits if they don’t have the Aadhaar,” Sudan added.
The government has also decided not to issue any new card or number as part of the scheme. “We tried distributing cards for Rashtriya Swasthya Bima Yojna (RSBY) but failed as it took us about a year to just distribute the cards. For this scheme, we will make use of the QR code already assigned to the families by the rural development ministry. The families can retain the code by printing it out,” Sudan said.
The health ministry has held a series of consultations with the state governments and insurance companies to discuss the implementation of the scheme.
“All states are on board. Even though Tripura wasn’t part of the consultations held last month, it hasn’t declined to implement the scheme. There has been a positive response from private insurance companies, too,” said Dinesh Arora, director, Ayushman Bharat. While West Bengal chief minister Mamata Banerjee had criticised the scheme, her state’s representatives had participated in the discussions.
The government has allowed the states to choose a financing model that works best for them — a private insurer, a Trust-based model or a mixed model, Arora said. Seven states use Trust models while Tamil Nadu has a mixed model system.
The operational guidelines will be shared with the states in April. “We will sign a memorandum of understanding (MoU) with the states individually once they finalise what they want to retain from our guidelines. We have planned meeting with the states at the zonal level in April and by May, there will be a robust IT network in place,” Nadda said, adding the training of officials working on the project will be conducted in June. “This will be the pilot stage to test its functioning and by July, the states will empanel eligible hospitals.”
Experts feel the first year won’t be a problem.
“The financial constraint shouldn’t be for this year. As insurance schemes work, and we have seen with RSBY, the typical hospitalisation is about 1% per family per year, so the average is no way going to be ₹5 lakh in a year,” said Ramanan Laxminarayan, director, Center for Disease Dynamics, Economics & Policy.
The insurers, too, are hopeful. “It’s a welcome move not just to maintain a healthy India but also will create several lakh/s new jobs in the country as new healthcare facilities will come up in smaller districts and villages,” said Antony Jacob, CEO, Apollo Munich Health Insurance.
