Where has Ayushman Bharat Reached?

The NDA government’s health initiative- Ayushman Bharat, also known in popular lingo as Modicare, finally began taking form in the fourth year of its governance. Termed as a National Health Protection Scheme (NHPS), it assures an annual health insurance cover of up to Rs 5 lakh per family for secondary- and tertiary-care hospitalisation to benefit 500 million (more than 10 crore poor families) poor and vulnerable people. Ayushman Bharat is set to be rolled out on 15th August, 2018. Upon implementation, Ayushman Bharat will be the world’s largest public-funded health insurance programme and could possibly be the Modi government’s greatest achievement. With elections a year away, and the introduction of GST and demonetization yet attracting mixed responses, this could kickstart a fresh narrative for the public opinion of the BJP.

While announcing the NHPS, Arun Jaitley stated that lakhs of poor families go to great lengths to obtain treatment. The government, he said, remains concerned about the consequent “impoverishment of poor and vulnerable families”. He further stated that the government was committing ₹1,200 crore for health and wellness centres. All-rounded health care, including non-communicable diseases, maternal and child health services, and free essential drugs and diagnostic services would be provided at the centres. Rashtriya Swasthya Bima Yojana (RSBY), the existing scheme in place, offers poor families an annual coverage of ₹30,000. Many states implemented enhanced health protection schemes which would provide varying coverage. These, he explained, were a component of the programme. Jaitley also said that the attempt would be to cover families belonging to every category- SC/ST, those under the Pradhan Mantri Jeevan Jyoti Beema Yojana, Pradhan Mantri Suraksha Bima Yojana and Pradhan Mantri Jan-Dhan Yojana. Collating all 60 crore basic accounts within its fold and undertaking techniques to provide facilities of micro insurance would be the methodology.

The Central and State Governments will share the expenditure incurred in premium payment in specified ratio as per guidelines issued by the Ministry of Finance. States/ UTs which implement the scheme through insurance companies, the total expenditure incurred will depend on actual market determined premium paid whereas in those which employ the Trust/ Society mode, Central funding would be calculated based on actual expenditure or premium ceiling (whichever is lower) in the pre-determined ratio. In April 2018, PM Modi opened the first health centre under the scheme on April 14, the birth anniversary of B R Ambedkar, in Bijapur, Chhatisgarh. In June, it was reported that eight states and four UTs had signed MoUs with the Union Health Ministry for the scheme. Delhi, Odisha, Punjab and West Bengal were among the ones who had not positively responded until then, owing to financial and political reasons. Signing the MoU implies formal commitment to implement the health programme along with the Centre. It also outlines the role of central and state governments and UT administrations in the same. Workshops were planned across the country to sign MoU with other states.

The Maharashtra government was reported to be reluctant in implementing the scheme. The state, which operated the Mahatma Jyotiba Phule Jeevandayi Yojana that 2.23 crore families including farmers in the suicide-prone districts of Vidarbha, was apprehensive about the financial burden that would fall on it. The situation was similar in Rajasthan, wherein the state government already implements the Bhamashah Swasthya Bima Yojana, under which cashless health care services are provided to around 4.5 crore people. Odisha refused co-operation stating its own scheme, Biju Swasthya Kalyan Yojana had more beneficiaries as compared to the AB-NHPS. Punjab too, is yet to give a green signal. West Bengal, initially disinclined, was the latest to come on board. In totality, 24 out of 36 States and UTs have provisions to cover a certain percentage of the population for cashless insurance services. Ayushman Bharat will absorb most of these services.

In June, the Indian Medical Association (IMA) expressed discontent and inclined towards rejecting the scheme claiming compromised quality of services and corruption as major consequences. Niti Aayog responded by saying that it would form a sub-group to look into the complaints lodged by private hospitals pertaining to pricing of treatment of key ailments proposed by the government. The government had presented a draft model tender document, which was shared with the states. Presently, the government will proceed with the prices on the basis of the draft model tender document. Niti Ayog stated that prices in the model were drawn from treatment provided by Rajasthan and Telangana for their healthcare schemes. As a latest development, the Health Ministry directed public and private hospitals to aid in implementing the scheme. The National Health Agency (NHA)- the apex body executing the scheme-launched a formal process to empanel hospitals. According to news reports, starting July 4, the State Health Agencies (SHA) through the State Empanelment Committees (SEC) commenced empanelling hospitals across the country. SHAs aim to ensure empanelment within specified timelines for speedy implementation, provided applicants meet essential criteria as defined by the government for different categories. Additionally, those undertaking speciality packages are required to fulfil extra criteria. Definite criteria for the same has been enlisted.

Workshops held at various levels were to brief officials on the empanelment criteria, packages, processes and queries redressal. Interested hospitals could then empanel themselves on Hospitals already enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) did not require re-empanelment.

So far, there is a huge unmet need for primary health care in India. A strong next generation needs a robust primary health-care system, save lives and build a healthier India. If we have to become the global superpower we are projected to become, our population needs to be fit, in order to be productive. Ayushman Bharat will directly lead to investment in health and employment generation and drive development and growth. It could a turning point for the health sector, and that of the country as well.

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