New Delhi: Announcing an allocation of Rs10,000 crore for the government’s ambitious health insurance programme, dubbed “Modicare", Union minister for health and family welfare J.P. Nadda on Thursday said the scheme will be fully functional by October.
The announcement came a day after the Union cabinet chaired by Prime Minister Narendra Modi approved the centrally sponsored Ayushman Bharat National Health Protection Mission (NHPM), labelled the world’s largest health insurance scheme. It aims to provide health cover to nearly 40% of the population—more than 100 million poor and vulnerable families—with the premium paid by the government.
“The beneficiaries have already been identified. The health ministry will start validating beneficiaries in April and ensure that the scheme is ready for implementation in four months’ time," said Nadda. “The NHPM under Ayushman Bharat programme is a major step towards universal health coverage. It will be the largest public funded health protection scheme in the world."
While Rs10,000 crore has been allocated to Modicare for 2018-19 and 2019-20, the government in February had initially announced an outlay of Rs2,000 crore. The funds will be used to cover costs such as setting up an information technology (IT) system, verifying entitled beneficiaries and paying premiums for states opting for an insurance model, said Nadda.
NHPM will be an entitlement-based scheme based on data from the deprivation criteria in the Socio Economic Caste Census. The beneficiaries can avail benefits in both public and empanelled private facilities. Unlike the Rashtriya Swasthya Bima Yojana (RSBY) that will be subsumed in NHPM, there will be no registration cards issued to beneficiaries.
“We will give specific QR codes to families entitled for the scheme. QR code or a barcode is a machine-readable optical label that will contain information about the families and their members. These codes will be sent to the beneficiaries’ addresses. Learning from RSBY we decided not to issue cards, for saving time as it took more than one year to distribute cards in RSBY," said Preeti Sudan, secretary, Union health ministry.
“All the pre-existing conditions will be covered from day one of the health insurance policy, all major surgeries or treatments such as cancer, heart surgeries will be covered, except a few such as organ transplants," she said.
In partnership with NITI Aayog, a modular, scalable, and interoperable IT platform will be made operational, which will entail paperless and cashless transactions. “This will also help in prevention, detection of any potential misuse or fraud or abuse cases. This will be backed by a well-defined grievance redressal mechanism," said Sudan.
In-patient hospitalization expenditure in India has increased nearly 300% during the past 10 years, according to data collected by the National Sample Survey Office for 2015. More than 80% of the expenditure is met out of pocket. Out-of-pocket expenditure in India is more than 60% of the total expenditure incurred on healthcare, which leads to nearly six million families slipping into poverty due to catastrophic health expenditures.
“The scheme will give underprivileged families the financial support required when faced with illnesses requiring hospitalization. It will protect around 50 crore people, or about 10 crore families, from catastrophic healthcare spending," said Nadda.