National Healthcare Protection Scheme better known as Ayushman Bharat.
Ayushman, a phrase often used to bless someone with long life essentially recognises the message it carries. The government looks at providing healthcare benefits to more than ten crore families belonging to the poor and vulnerable economic strata. Fifty crore beneficiaries approximately will be provided with a coverage for five lakh rupees per family per year for secondary and tertiary care hospitalisation. This mission will become functional under the on-going centrally sponsored schemes- the Senior Citizen Health Insurance Scheme (SCHIS) and Rashtriya Swasthya Bima Yojana.
The eligibility criteria of the Ayushman Bharat scheme is widely divided into the urban and rural regions of dwelling.
In rural dwellings, the following are to be looked at apart from the SECC database,
In urban areas the eligibility criteria are vastly different and consist of a list of eleven occupational categories of workers. They are:
The data generated during the implementation will help in designing future health care programmes with better target.
The flip-side includes the Health and Wellness Centres (HCWs) which remains aloof from the media coverage. The primary health centres and health sub-centres of the country are presently limited to elements of maternal and child care and a couple of major infectious diseases. The HWCs are envisioned to broaden the domain of these centres and provide care for other chronic illness and infections.
With that comes the challenges:
We are yet to obtain commitments in these regards.
The major limitation of the scheme is the absence of any preventive or outpatient care.
The National Health Protection Scheme (NHPS), now known as Modicare lacks adequate funding and overlaps with several existing schemes of the State health insurance. The initially amount of Rs. 2,000 crore being allocated to cater 50 crore households is pathetically meagre, as each person each year would be entitled to Rs. 40 only. Even the Rs. 11,000 crores later projected is less than half of the minimum amount required for the scheme.
Thus we can effectively conclude that the NHPS is a publicly-funded health insurance programme within a limited budget. It aims to protect the poor from the secondary and tertiary healthcare costs which is NOT a novel design. Several such insurances already exist in States. Besides the need of care providers and hospitals in several regions is primary which requires a public investment. In the private sector, a need of regulation is needed to determine the importance of health care needs of the under-privileged. Alternatively, the NHPS could have designed a more flexible route to finance tertiary care from public hospitals as well as less commercially oriented niches of the private sector to fill the existing insurance gaps.It could finance the already existing insurance programmes of the states instead of offering a frugal replacement. In this scenario it could have made an effective contribution in the states where there was not an already existing scheme, having learnt form experience.
The NHPS could have instead offered to supplement the existing public hospitals and healthcare facilities, which could benefit India’s healthcare scenario without enabling the corporate sector any more profit.