Ayushman Bharat

Brig Anil Gupta
Health has taken centre stage among the various welfare schemes launched by the Modi Government across various sectors.  Affordable healthcare and a disease free India has been one of the focus areas of the Modi Government ever since it assumed office four years ago. Even the schemes like Swacch Bharat and Ujjawala are aimed at eliminating diseases since only a clean India can be a disease-free India. Ujjawala that aims at smoke-free kitchens will boost the health of beneficiary womenfolk. The most challenging and ambitious scheme to this end has been launched by the government in its fourth year. Ayushman Bharat is one of the big new ideas floated by the Narendra Modi-led National Democratic Alliance (NDA).Ayushman Bharat, if implemented properly will be a trendsetter in provision of affordable healthcare to more than half of the nation’s population with governmental intervention. Ayushman Bharat National Health Protection Mission (AB-NHPM), dubbed Modicare, will provide a cover of Rs5 lakh annually to 100 million poor and vulnerable families. It is touted by the Bharatiya Janata Party (BJP)-led National Democratic Alliance (NDA) as the world’s largest healthcare programme. It is estimated to cost about Rs12,000 crore annually.
To be rolled out in collaboration with the state governments, AB-NHPM is expected to reduce Out Of Pocket (OOP) expenditure. The in-patient hospitalization expenditure in India has increased nearly 300% during last 10 years according to the National Sample Survey Office (NSSO) 2015. Currently, OOP expenditure in India is over 60%. “It will make treatment affordable and accessible for poor as it covers practically everything in secondary and tertiary care. Close to 40% of our population will have access to hospitalisation after this scheme is implemented,” according to Dr VK Paul, member, NitiAyog. Each year, 7-8 million people, who are not poor, become poor because of expenses incurred during medical treatment. This scheme will change that. While the financing model is partly dependent on the states, and the scheme will subsume all existing public health insurance schemes, its effectiveness and reach will depend on the availability of quality healthcare services, which varies widely across states. To meet the shortage of doctors, nurses and other trained health professionals, the NDA announced the setting up of 14 new All India Institute of Medical Sciences (AIIMS) institutes since 2014 even though as many as six AIIMS announced by the previous government are going through severe birthing pangs because of a shortage of faculty and medical staff. The government will need to do a serious thinking since, merely opening of the AIIMS is not able to meet the challenge. The government has also enhanced manifold vacancies for post-graduation and super-specialisation courses, which may to some extent mitigate the problem.
The ambitious healthcare scheme will be covering almost all secondary and many tertiary hospitalizations with coverage of Rs5 lakh for each family. AB-NHPM will subsume the on-going centrally sponsored schemes RashtriyaSwasthyaBimaYojana (RSBY) that offers a cover of Rs30,000 and the Senior Citizen Health Insurance Scheme (SCHIS) that offers up to Rs30,000/- per annum per senior citizen.
The National Health Mission (NHM) will be the main vehicle for the Universal Health Coverage and will focus on strengthening the public health systems, particularly in high priority districts that include aspirational districts. The salient features of the NHM will be a shift from selective to comprehensive primary healthcare that includes care for common non-communicable diseases, geriatric healthcare, palliative care and rehabilitative care services, etc., through strengthening of the sub centres and primary health centres as Health and Wellness Centres (HWCs). In pursuance of the same the government has approved continuation of the National Health Mission (NHM)-with effect from 1 April 2017 to 31 March 2020-with a budgetary support of Rs85,217 crore as central share over this period.The NHM will complement AB-NHPM, by reducing OOP expenditure through intensification of initiatives such as NHM Free Drugs and Diagnostics Services Initiatives, Pradhan Mantri National Dialysis Programme.
Listed below are the 10 ways Modi government’s Ayushman Bharat – National Health Protection Mission will help the citizens:
* The scheme will provide a coverage of Rs 5 lakh per family per year and benefit more than 10 crore families belonging to the poor and vulnerable sections of the society.
* To ensure that nobody is left out, especially women, children and the elderly people, there will be no cap on family size and age in the scheme.
* The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy.
* The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the states implementing AB-NHPM will be deemed empanelled for the scheme.
* Hospitals belonging to ESIC may also be empanelled based on the bed occupancy ratio parameter. As for private hospitals, they will be empanelled online based on defined criteria.
* The AB-NHPM 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 areas.
* The different categories in the rural areas include families having only one room with “kachaa” walls and “kachaa” roof, families having no adult members among others. Also, automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour. For urban areas, 11 defined occupational categories are entitled under the scheme.
* The scheme structure will ensure appropriate integration with the existing health insurance or protection schemes of various central ministries/departments and state governments (at their own cost). The state governments will be allowed to expand AB-NHPM both horizontally and vertically.
* AB-NHPM will have a major impact on the reduction of Out Of Pocket (OOP) expenditure on the ground of an increased benefit cover to nearly 40 per cent of the population, which will lead to an 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.
* The Ayushman Bharat scheme will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus, leading to an improvement in the quality of life.
A major spin-off the scheme is the likely boost it is going to give to creation of state of the art health infrastructure in the many towns and cities across the country. It is also likely to generate employment.
(The author is State Spokeperson Bharatiya Janata Party, J&K)
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