August 2018

Ayushman Bharat–The Gamechanger for Building New India

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Ayushman bharatIf we had all the money in the world we wouldn’t need Ayushman Bharat – people could afford their own medical care, someone stated recently on social media. It narrated a collective agony so succinctly. This medical insurance scheme holds huge significance perhaps for this very reason for public at large, especially in Bharat (the rural India), writes Sandeep Datta of Elets News Network (ENN).

Popularly described as Ayushman Bharat, the Pradhan Mantri Jan Arogya Yojna (PMJAY), is Prime Minister Narendra Modi’s signature medical insurance scheme. It is reportedly set to be rolled out across the nation on September 23, two days ahead of the birth anniversary of Rashtriya Swayamsewak Sangh (RSS) ideologue Pandit Deen Dayal Upadhayaya.

A look at the way the Government machinery is promoting the universal healthcare scheme — Ayushman Bharat, indicates there is a strong desire of Narendra Modi Government to ensure a sea change in terms of transforming the country’s healthcare scenario for all.

The scheme reflects determination to provide succour to the poorest of the poor and the middle-class in terms of healthcare. For many political pundits, the Ayushman Bharat may be a major move timed just ahead of the parliamentary and State assembly polls. For satirists, it may be just another political gimmick. But for a lot of commoners, it feels something what they longed for in the country.

With this national health protection scheme, the Modi Government aims to cover over 100 million poor and vulnerable families (approximately 50 crore beneficiaries). It will be done by providing an annual coverage of up to 5 lakh rupees per family for secondary and tertiary care hospitalisation. It will subsume the ongoing centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Billed as the world’s biggest public healthcare programme, Ayushman Bharat, or the National Health Protection Mission (AB-NHPM), was announced in the 2018-19 Budget and approved by the Cabinet in March. It is widely expected to vault over all other social welfare projects of the BJP-led National Democratic Alliance government, like Swachh Bharat, free LPG connections to the poorest families, electricity to all homes, and Jan Dhan bank accounts.

The Flip Side

A section of the society opines Ayushman Bharat is very much required for people living in villages, towns, cities and States across India but not that much in South India. It is so because various healthcare schemes have been already existing and benefitting people in the South for a long time.

While appreciating the scheme, a section of the society looks at it with questioning eyes in terms of implementation challenges, that are to determine its success or failure.

Another section of society feels the Government must think of providing coverage for crop insurance and medical coverage reciprocal to land holding by increasing the annual land rent which will take care of farmers’ maladies.

Some others stress upon the absence of medicare scheme for the elderly retired people, as they simply cannot afford any costly medical insurance scheme as it is present with the insurance companies.

Can South India Inspire?

A look at the existing healthcare infrastructure and plethora of ongoing projects in various parts of the southern States, one can derive some inspiration about how much comprehensively these are expected to ensure healthcare for all.

Andhra Pradesh is one such example from South India. To develop a healthy State, the Nara Chandrababu Naidu-led TDP government has undertaken a slew of measures. These initiatives seek to offer quality medical facilities that are accessible and cost effective as well for all segments of society. From ‘Arogya Raksha’ to ‘Chandranna Sanchara Chikitsa’ or the ‘Feeder Ambulances (108 Bike) , the State government has implemented many programmes to improve overall health of the State.

PM’s Push to Expedite Ayushman Bharat scheme

Giving a call to speed up pace on Ayushman Bharat, the Prime Minister recently expressed concern over seven Opposition-ruled States not signing up, asking seven States including Maharashtra, Rajasthan, Bihar and Sikkim to “make more efforts” to ensure the scheme is rolled out on time.

Prime Minister’s concern to speed up matters in seven States came in the wake of other States like Uttar Pradesh and Haryana already having started pilot runs of ‘Ayushman Bharat’ scheme.

He also expressed concern over seven States not signing the Memorandum of Understanding (MoU) with the Centre so far for rolling out the scheme. All these seven states are ruled by opposition parties, with Odisha refusing to sign the MoU and launching its own parallel health insurance scheme.

During a press conference held on August 28, the Union Health Ministry stated Delhi, Kerala, Tamil Nadu, Punjab and Karnataka were “likely” to come on board for MoUs while there was “no information” from Telangana and Odisha.

Developments on various fronts so far…

On September 6, The Karnataka government softened its initial stand with regard to implementing the Centre’s Ayushman Bharat national health protection scheme, and decided to blend it with State’s own Arogya Karnataka healthcare programme.

On September 7, in Jammu, the ambitious “Ayushman BharatPradhan Mantri Jan Arogya Yojana (AB-PMJAY)” meant to provide the poor and vulnerable families coverage for secondary and tertiary care hospitalisation was launched.

After inaugurating the pilot launch of the scheme, Deputy Commissioner Ramesh Kumar underlined the AB-PMJAY is aimed at providing portable coverage of Rs 5 lakh per family annually, and a beneficiary covered under the scheme would be allowed to avail cashless benefits from any public and private empanelled hospitals across the country.

Haryana woman — First Beneficiary of Ayushman Bharat scheme

In August, Mausami, a Haryana woman turned first beneficiary of Modi government’s flagship healthcare programme, the Ayushman Bharat scheme.

On the Independence Day, she delivered a baby girl Karishma at the Kalpana Chawla Government Hospital in Haryana’s Karnal area through cesarean section.

Expressing her gratitude for the scheme, Mausami, who received a benefit of Rs 9,000, said, “The government will bear all medical expenses. This scheme is very good.”

The first claim also evoked a tweet from Harayana Chief Minister Manohar Lal Khattar @mlkhattar: “Heartening to see the first claim raised and paid under the Ayushman Bharat scheme, or the cesarean delivery of baby girl in Haryana.”

Also, the National Health Agency @AyushmanNHA tweeted: “First claim raised under #AyushmanBharat. A baby girl is born through caesarean section at Kalpana Chawla Hospital in Haryana. Claim of RS 9000 paid to the hospital by Ayushman Bharat- Haryana. @AyushmanNHA welcomes the young angel!”

Vision, Scope, and Significance — Ayushman Bharat Scheme

The government’s flagship health insurance scheme, Ayushman Bharat, is credit positive for insurance companies as it will aide in higher premium growth, a recent report said.

As per latest observation of international rating agency Moody’s “The launch of universal health coverage is credit positive for the country’s insurers because it will help grow health premiums and provide insurers with cross-selling and servicing opportunities.”

Prime Minister Modi, in his Independence Day speech from the ramparts of Red Fort, said the Ayushman Bharat-National Health Protection Mission (AB-NHBM) will be launched on September 25.

It is worth understanding that Ayushman Bharat – National Health Protection Mission will subsume the ongoing centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Health insurance contributes around 23 percent of general insurance premiums and is one of insurers’ main drivers of growth, according to the report.

The Prime Minister Highlighting Ayushman Bharat on social media:

1 February, 2018

Ayushman Bharat Yojana is a path breaking initiative to provide quality and affordable healthcare. It will benefit approximately 50 crore Indians. The scale of this scheme is unparalleled and it will bring a paradigm shift in our health sector.”

On 15 Feb, 2018

“Laid the foundation stone of the Academic Block of the Tomo Riba Institute of Health and Medical Science. Talked about Centre’s efforts to transform the health sector. Through Ayushman Bharat, India’s poor will get top quality and affordable healthcare.”

On 12 March, 2018

Ayushman Bharat is going to transform the health sector. It will provide top quality healthcare to the poor.”

PMO, on behalf of Narendra Modi, tweeted:

7 April, 2018

“I welcome the theme ‘Universal health coverage: everyone, everywhere’ that has been chosen by @WHO and others. It is the quest for #HealthForAll that inspired us to create Ayushman Bharat, the largest healthcare programme in the world.”

15 August, 2018

“Pradhan Mantri Jan Arogya Abhiyaan will be launched on 25th September this year. It is high time we ensure that the poor of India get access to good quality and affordable healthcare”

“The healthcare initiatives of the Government of India will have a positive impact on 50 crore Indians. It is essential to ensure that we free the poor of India from the clutches of poverty due to which they cannot afford healthcare”

23 August, 2018

“The coming of Pradhan Mantri Jan Arogya Yojana- Ayushman Bharat will transform the health sector and ensure the poor get top class healthcare and that too at affordable prices”

Roadmap of Scheme’s Implementation:

At the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (ABNHPMA) would be put in place. States/ UTs would be advised to implement the scheme by a dedicated entity called 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/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

Understanding Ayushman Bharat — Key Points

• An annual cover of Rs 5 Lakhs per family for secondary and tertiary care

• No money required to be paid by family for treatment in case of hospitalisation

• Avail free treatment by visiting public or empanelled private hospitals across the country

• Carry any prescribed ID to receive treatment at the hospital

• All pre-existing conditions are covered from day one of the policy. The benefit cover will include pre & post hospitalisation

• No restriction on family size, age or gender • All members of eligible families as present in SECC database are automatically covered

• The beneficiaries can avail benefits in both public and empanelled private facilities.

• The scheme’s benefits are portable across the country. A beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

Role of Nodal Agencies

As per the Government’s plans at the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (ABNHPMA) would be put in place.

The States and Union Territories would be suggested to implement the scheme by a dedicated entity called 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.

The States and UTs will be authorised to decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

Key Impact

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 hospitalisations (except a negative list)

Coverage of 5 lakh for each family, (no restriction of family size)

Expenditure Involved

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.

Number of Beneficiaries

Ayushman Bharat – National Health Protection Mission will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban.

STATES/DISTRICTS COVERED

Ayushman Bharat – National Health Protection Mission will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries.

The Roadmap To Implementation

As per the Government’s plans at the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (ABNHPMA) would be put in place.

The States and Union Territories would be suggested to implement the scheme by a dedicated entity called 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/ UTs will be authorised to decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

On 23 September, Prime Minister Modi is all set to launch the Ayushman Bharat health scheme from Ranchi.

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