Roll-out of Ayushman Bharat – National Health Protection Mission (AB-NHPM):
- The scheme seeks to provide health coverage of Rs 5 lakh per family per year.
- The programme is starting on a pilot basis in 80-100 districts in Haryana, Uttarakhand and Chhattisgarh, among others.
- All people whose names appear in the latest socio-economic caste census (SECC) will be eligible to be covered under AB-NHPM.
- The second phase of the project will be launched and gradually it will be expanded to other parts of the country.
Some states not yet on board:
- Of the 36 states and Union territories, 28 are already on board.
- Maharashtra, Karnataka, Kerala, Tamil Nadu, Punjab, Odisha, Telangana and Delhi aren’t.
- The Mission officials are in talks with the states concerned to convince them to join this programme so people in their states aren’t bereft of the scheme.
Integrating States that have their own insurance programmes:
- States like Tamil Nadu already have successful state-run health insurance programmes.
- NHPM is providing a coverage of Rs 5 lakh per family which is higher than what most states offer.
- For example, Tamil Nadu offers coverage of Rs 2 lakh.
- The states have been told they can integrate their existing schemes with the Centre’s using a common logo and name.
Various aspects of the programme:
- The government said there is no cap on funding for this project.
- The initial allocation for this project was about Rs 2,000 crore.
- Once the project is running in its full capacity, Rs 20,000 – 30,000 crore would be required, of which 60% has to come from the Centre.
- The first phase of the project, being started on pilot basis on August 15, involves only the public hospitals.
- But the Mission is in the process of identifying and empanelling many private hospitals too for the additional demand.
- Once the project is running full scale, many new private hospitals are expected to come up to cater to the needs of the patients even in rural parts of the country.
- Are the rates offered attractive enough to private hospitals?
- There is a lot of dependence on private hospitals for success of the scheme.
- But the rates decided by the government for various procedures haven’t really attracted their attention. Indian Medical Association (IMA), too, has demanded increase in package rates.
- The Mission says that the package rates have been decided after consulting many doctors and owners of hospitals.
- Rates can be reviewed if necessary:
- If states feel they want to increase it by up to 10%, they are free to do so.
- If that too doesn’t work and there is consensus, the government is open to reviewing the rate of such packages. IMA and other key stakeholders are being consulted.
Protecting against fraud:
- Unnecessary procedures, like caesarean section for child delivery, and fake bills are common frauds that plague existing insurance programmes.
- To check that, under AB-NHPM, Caesarean section, hysterectomy and treatment of mental illnesses cannot be availed in private hospitals. This will be available only at public hospitals.
- To check other frauds, a robust IT system will monitor and raise an alarm over inconsistencies.
- It will have triggers to flag instances such as same patient being admitted multiple times and hospitals admitting more patients than their bed capacity.
- There will be two toll-free numbers for the state and the Centre respectively where people can complain about any inconsistency or clarification needed with respect to insurance coverage.
GS Paper II: Social Issues