On Independence Day, the Prime Minister announced the launch of Pradhan Mantri Jan Arogya Abhiyaan, also known as Ayushman Bharat or Modicare. This government-sponsored health insurance scheme, set to be launched on 25 September 2018, is intended to benefit poor and economically-deprived individuals across India. However, not everyone is eligible for this free medical insurance scheme.
Key Features of Ayushman Bharat
Ayushman Bharat aims to provide free health coverage of up to Rs 5 lakh per family per year, applicable in both government and empanelled private hospitals across India. The scheme covers secondary and tertiary medical care facilities for approximately 74 crore beneficiary families, which equates to about 50 crore Indian citizens. The selection of beneficiaries, constituting around 80 percent of the total, is based on the Socio-Economic Caste Census data from both rural and urban areas. Notably, there are no restrictions based on family size, age, or gender under this scheme.
Policy Benefits and Financial Structure
The Ayushman Bharat policy differs from other medical insurance schemes as it has no waiting period for pre-existing diseases. All types of illnesses are covered from the first day of policy implementation. The benefits include cover for both pre and post hospitalization expenses. The premium payment expenditure will be shared between the Central and State Governments according to a specified ratio.
Funding for the scheme will be divided in the following ways – 60:40 for all states, 90:10 in Northeast states, Himalayan states, and 100% Central funding for union territories without legislature. The premiums are expected to range between Rs 1,000 – Rs 1,200 per annum. The National Health Protection Mission (NHPM) will cover hospitalisation costs of beneficiaries by strategically purchasing services from public and private hospitals.
Wellness Centres Under Ayushman Bharat
As part of the scheme, 1.5 lakh sub-centres will be converted into wellness centres providing a variety of services including detection and treatment of cardiovascular diseases, cancer screening, mental health care, elderly care, eye care, maternal and child health services, vaccinations against selected diseases, and more.
Expected Benefits of the Scheme
If implemented correctly, this scheme could greatly increase access to healthcare services for a significant section of society who may otherwise not be able to afford them, thereby moving the country towards universal health coverage. Additionally, the wellness centres planned under Ayushman Bharat can play a preventive role by reducing the incidence and impact of non-communicable diseases.
Funding Mechanism of NHPS
The financial viability of NHPS hinges on the insurance principle of ‘risk pooling’, where healthy individuals subsidise the costs for those who fall sick in a given year. Even with high coverage offered to sick individuals, the scheme remains financially sustainable as a majority of the larger pool will not require monetary support within the same timeframe.
Challenges and Future Tasks
There are several challenges ahead, such as reaching a consensus on treatment costs, setting up an expansive IT network for cashless treatment, and improving public hospital infrastructure in rural areas. Furthermore, the scheme also brings attention to other issues such as limited and uneven distribution of human resources in health services, vacancies in health worker posts, and regular shortages of doctors in primary health care centres. Without addressing these critical aspects, public sector healthcare quality will remain poor, forcing patients to turn to the private sector. This could potentially become unsustainable and even detrimental for the economically deprived citizens for whom the scheme is primarily intended.