‘Health insurance may require Rs 20,000-30,000 crore … first phase involves only the public hospitals’
August 15, 2018, 2:00 AM Beginning today, the Narendra Modi government’s health insurance scheme Ayushman Bharat – National Health Protection Mission (AB-NHPM) will be rolled out. Indu Bhushan, CEO of the project, in a conversation with Durgesh Nandan Jha explains the features of the plan and the challenges in getting states on board:
Is there going to be a nationwide rollout of Ayushman Bharat – National Health Protection Mission?
No. At present, we are starting it 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 will be eligible to be covered under AB-NHPM that seeks to provide health coverage of Rs 5 lakh per family per year. In October, the second phase of the project will be launched and gradually it will be expanded to other parts of the country.
Many states, including Maharashtra, which has a BJP chief minister, are yet to join the health insurance programme. What is the government doing to bring them 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. We are in talks with the authorities concerned to convince them to join this programme so people in their states aren’t bereft of the scheme. I am hopeful they will be convinced. As for Maharashtra, they have financial issues due to farm loan (waiver) and other exigencies, but they will certainly be on board soon.
States like Tamil Nadu already have successful state-run health insurance programmes. Do you think they will be willing to integrate their projects with the Centre’s?
We are providing a coverage of Rs 5 lakh per family which is higher than what most states offer. Tamil Nadu, for example, offers coverage of Rs 2 lakh. We are, therefore, telling the states to join AB-NHPM so people benefit from it. The states have been told they can integrate their existing schemes with the Centre’s using a common logo and name.
Where is the fund to run such a large project? What is your assessment on the approximate amount that Centre and states will have to put together to make AB-NHPM a success?
There is no cap on funding for this project. We will get whatever is needed, the government has said. The initial allocation for this project was about Rs 2,000 crore and we have already asked to make it over Rs 4,000 crore in the supplementary budget. I feel that once the project is running in its full capacity we may require Rs 20,000 crore to Rs 30,000 crore of which 60% has to come from the Centre.
And what about the infrastructure requirement. Do we have enough hospitals on board to provide treatment to people covered under this scheme?
The first phase of the project, being started on pilot basis on August 15, involves only the public hospitals. But we are in the process of identifying and empanelling many private hospitals too for the additional demand. Once the project is running full scale, we believe many new private hospitals will come up to cater to the needs of the patients even in rural parts of the country, because they will now be covered under the insurance scheme; government will pay for their treatment. It will help us make the project a success.
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.
We have consulted many doctors and owners of hospitals to come up with package rates. They aren’t too little. Also, 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, we are open to reviewing the rate of such packages. IMA and other key stakeholders are being consulted.
Unnecessary procedures, like caesarean section for child delivery, and fake bills are common frauds that plague existing insurance programmes. Is there any mechanism to check that in AB-NHPM?
Caesarean section, hysterectomy and treatment of mental illnesses cannot be availed in private hospitals under AB-NHPM. This will be available only at public hospitals. To check other frauds, we have a very robust IT system that 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.
Will the programme also have any grievance mechanism?
Yes. We are planning to have 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.
DISCLAIMER : Views expressed above are the author’s own.
Durgesh Nandan Jha is The Times of India’s leading health correspondent. He has been writing on this sector for over a decade, focussing mostly on disease. . .
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