Ayushman Bharat: Is Modicare the step forward?

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Ayushman Bharat euphemistically termed ‘Modicare’ is a National Health Protection Scheme which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year at any government or even empanelled private hospitals all over India for secondary and tertiary care hospitalization. By comparison, Obamacare rolled out in 2010 targeted 50 million people.

This scheme announced in the Union Budget of 2018 by the Finance Minister, Mr. Arun Jaitley and is touted to be the largest ever government sponsored scheme launched by any country in the world so far.

How will it benefit the poor?

Eligibility for the scheme is based on the Socio-Economic Caste Census (SECC) database. The cover provided by AB-NHMP will take care of almost all secondary and tertiary care expenses. There is no restriction on family size and age to ensure that nobody is left out. It will also cover pre and post hospitalization expenses. According to the scheme, beneficiaries will also be paid a definite transportation allowance.

What is its cost for the government?

It will be funded in the ratio of 60:40 by center and state respectively. According to reports, the scheme is expected to cost the government about Rs 10,000 crore annually. The central government’s step to include poor people, semi-urban households under this scheme was the need of the hour.

Problems it is expected to face

  1. Implementation and Integration

One of the biggest hurdles for this scheme is its implementation at the state level. There are many other existing centrally sponsored schemes like National Health Mission, Rashtriya Swasthya Bima Yojana (RSBY), the big challenge lies in integrating the schemes of central government and state governments. While the center provides insurance cover for only secondary and tertiary services, some states provide cover for primary services as well. If we continue with both the schemes then there would be a huge loss of public money.

2. Technology and Infrastructure

Even if the two schemes are merged, there is a need of specialized technology and infrastructure which will be required for processing the insurance claims, prevention of malpractices and provision of medical services to patients. Since neither the centre nor state has so it is extremely important for the private sector to participate in this scheme. However, most private players don’t see any financial viability under this scheme. Private hospitals have pointed out that the package rates are unscientific, arbitrary and insufficient and have indicated that they would be unwilling to participate in this scheme.

According to a study conducted which compare the cost which private hospitals incurred, on a range of procedures, with the reimbursements offered by the government, for those who use these private hospitals, under the CGHS. For example, for implanting a bare metal cardiac stent, the Karnataka government’s costing study said it would cost Rs 85,818. CGHS is reimbursing nearly the entire amount at Rs 80540. But AB-NHPS is offering Rs 65000. This is a similar case for several other procedures.

Unless the rates are revised, the private players will not be incentivized to participate under this scheme since it doesn’t cover their costs.

Conclusion

Though the government has a noble intention behind this scheme, but it seems that there is no solid plan for its execution. It is extremely important that the center and state government, private hospitals, entrepreneurs, insurance companies, health centres work together to make this scheme successful. With 2019 Lok Sabha elections approaching, this scheme will either turn out to be a masterstroke for BJP or it might burn a hole in their sailing ship.

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