Ayushman Bharat - National Health Protection Mission (NHPM)

April 12, 2018

Ministry: Ministry of Finance

Why Ayushman Bharat?

  1. Even after 70 years of Independence, 80% of Indian population is not covered under any health insurance scheme and the average cost of in-patient treatment is almost half of person's household expenditure.

 

Features of Ayushman Bharat Scheme:

  1. Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.

  2. Ayushman Bharat - National Health Protection Mission will subsume the on-going centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

  3. 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.

  4. Entitlement based scheme with entitlement decided on the basis of deprivation criteria in the Socio-Economic Caste Census (SECC) database.

  5. One of the core principles of Ayushman Bharat - National Health Protection Mission is to co-operative federalism and flexibility to states.

  6. For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.

  7. States would need to have State Health Agency (SHA) to implement the scheme.

  8. To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat - National Health Protection Mission to State Health Agencies may be done through an escrow account directly.

  9. In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.

  10. The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue. The total expenditure will depend on actual market determined premium paid in States/ UTs where Ayushman Bharat - National Health Protection Mission will be implemented through insurance companies.

Major Impact of Ayushman Bharat Scheme:

 

Ayushman Bharat - National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of:

  • Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable)

  • Covering almost all secondary and many tertiary hospitalizations. (except a negative list)

  • Coverage of 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, job creation thus leading to improvement in quality of life. 

Challenges:

 

Challenges need to be seen holistically as defined by NITI Aayog to include key determinants of health, a range of resources like food supply chain and nutrition.

 

  1. Economic development, inclusive growth and equity:

    1. The proportion of people living on less than US$ 1.25 a day purchasing power parity (PPP) decreased from 60% in 1981 to 42% in 2005, but the actual number of people living on less than US$ 1.25 a day PPP increased from 435.5 million in 1990 to 455.8 million in 2005.

    2. Inter-state differences in health status remain; for instance, there is an 18 year difference in life expectancy between Madhya Pradesh at 56 years and Kerala at 74 years.

  2. Health Financing:

    1. ​​Governmental expenditure is only around 1.4% of GDP, with only 32.4% of the total spending as general Government contributions, some 15–20 percentage points below that of the United States or America, China and Brazil, and 40–45 percentage points below those of the European Union averages and Japan.

  3. Human Resource for Health: 

    1. The number of doctors with recognized medical qualifications under the Medical Council of India (MCI) Act and registered with state medical councils was only 0.9/1000 inhabitants in 2010 (some 816,629 doctors plus 104,603 registered dental surgeons); there are also 752,254 registered AYUSH (traditional medicine) doctors.47 The number of nurses is also 0.9/1000 inhabitants in India.

    2. Challenges also relate to the distribution of staff per 1,000 population. Urban areas are much better served than rural areas (1.3 versus 0.39 doctors; 4.2 versus 1.18 total health workers; 1.59 versus 0.41 nurses and midwives).

  4. Provision of health services:

    1. India is endowed with only 0.6 beds per 1000 population.

    2. Around 68% of an estimated 15,097 hospitals and 37% of 623,819 total beds in the country are in the private sector. Of these most are located in urban areas.

Suggestions:

  1. Standardisation of Services: The quality of healthcare provided by various health care institutions is not equivalent. Although, NABH provides accredition but only small number of hospitals are accredited to NABH. Therefore, categorisation of hospitals into Entry level, Progressive level and Accreditation level — as specified by NABH — is necessary to overcome issues related to diversity of providers.

  2. Costing: Reimbursement slabs should be objective, transparent and linked to accreditation according to the hospital categories. National Costing Guidelines and a standard costing template should be used for calculating reimbursement packages.

  3. Technology: Integration of technology at each level of the healthcare continuum such as tele-medicine for remote locations, health call-centres, tele-radiology, app based emergency response etc.

  4. Healthcare professionals: Strengthening the number of healthcare professionals, through skilling, re-skilling and up-skilling programmes for existing as well as additional workforce.

     

 

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