New Delhi: The government is set to launch the Ayushman Bharat-National Health Protection Mission (AB-NHPM) on 25 September, the birth anniversary of Bharatiya Jana Sangh leader Deendayal Upadhyaya.

The ambitious scheme, also known as Modicare, aims to offer an annual health cover of 5 lakh per family, targeting more than 100 million families belonging to the poor and vulnerable sections of the population, based on Socio-Economic Caste Census (SECC) database. The ministry of health and family welfare will be implementing the scheme.

The annual health cover of 5 lakh per family will allow beneficiaries to avail cashless benefits from any public or private empanelled hospital in India. It is an entitlement-based scheme which was drafted on the basis of the deprivation criteria in the SECC database. The expenditure incurred in premium payment will be shared by the central and state governments.

The scheme focuses on cooperative federalism and flexibility to states. At the national level, an AB-NHPM agency will be established. States and Union territories (UTs) will be advised to implement the scheme through a dedicated entity, the state health agency (SHA). They can either use an existing trust, society, not-for-profit company, state nodal agency (SNA) or set up a new entity to implement the scheme. States and UTs can decide to implement the scheme through an insurance company or directly through a trust or society, or use an integrated model. For giving policy directions and fostering coordination between the centre and states, it has proposed to set up an AB-NHPM council at the apex level, chaired by the Union health and family welfare minister. To ensure that the funds reach SHA on time, the transfer of funds from the central government through Ayushman Bharat to state health agencies may be done through an escrow account. In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform has been made operational, which will entail paperless and cashless transactions.

Impact

With effective implementation, the scheme may have a positive impact on reducing out-of-pocket expenditure. The government argues that the poorest and the vulnerable will have health insurance. The scheme will initially cover nearly 40% of the population. Barring a few procedures, the scheme covers almost all secondary and many tertiary hospitalizations, which in normal circumstances, bankrupt poor people. This can have a cumulative positive effect on 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 may lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, and job creation, leading to improvement in overall quality of life.

The challenge ahead

A recent PwC-Confederation of Indian Industry (CII) report on AB-NHPM highlighted that the government will require the right infrastructure to meet the new bed capacity demand. At least 33% of the people covered by the scheme will have no previous health insurance coverage and will have a hospital admission incidence rate of 6% with an average three-day stay.

Currently, there are 1.35 million hospital beds for around 180 million people covered under the Rashtriya Swasthya Bima Yojana, according to the report.

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