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WHY??

  • National Health Policy 2017 envisages universal access to good quality health care services without anyone having to face financial hardship as a consequence.
  • National Health Accounts Estimates 2013-14: A staggering 2 per cent of health expenditure, is met by households out-of-pocket.  Preventive care gets just 9.6 per cent of the total money that flows in India’s healthcare system .
  • Large informal sector work force: No social security of formal sector.

PRESENT SCHEMES?

  • Rashtriya Swasthya Bhima Yojana: Rs. 30,000/- per annum for a household of five.

PROPOSALS UNDER NHPS?

  • AB-NHPM will have a defined benefit cover of 5 lakh per family per year.
  • The scheme is portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
  • AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database
  • To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all the costs associated with treatment.
  • For beneficiaries, it will be a cashless, paper less transaction.
  • One of the core principles of AB-NHPM is to co-operative federalism and flexibility to states. There is provision to partner the States through co-alliance. This will ensure appropriate integration with the existing health insurance/ protection schemes of various Central Ministries/Departments and State Governments (at their own cost), State Governments will be allowed to expand AB-NHPM both horizontally and vertically. States will be free to choose the modalities for implementation. They can implement through insurance company or directly through Trust/ Society or a mixed model.
  • For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
  • In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction. This will also help in prevention of  fraud / abuse cases.
  • This will be backed by a well-defined Grievance Redressal Mechanism.

CHALLENGES?

  • FUNDS
  • NHPS will need more than the ₹2,000 crore presently allocated.
  • Reduced allocation for the National Health Mission and sidelining of its urban component raise concerns about primary care.
  • CENTRE-STATE SHARE
  • NHP asks the States to raise their allocation for health to over 8% of the total State budget by 2020, requiring many States to double their health spending.
  • States have to contribute 40% of the funding. Even with the low cost coverage of the RSBY, several States opted out.
  • Some decided to fund their own State-specific health insurance programmes, with distinctive political branding.
  • NHPM has a national character, with beneficiaries being able to port the service anywhere . Thus States play a crucial role in its implementation.
  • OUT PATIENT CARE
  • Delays in seeking medical care.
  • Increase total cost of health care during advanced stages of illness.
  • PROBLEMS OF A ONE SIZE FITS ALL MODEL
  • Increase premiums for risks that virtually do not exist.
  • PRIMARY HEALTH CARE
  • Not sufficiently addressed in NHPS.
  • If primary health services are not strong enough to reduce the need for advanced care and act as efficient gatekeepers, there is great danger of an overloaded NHPS disproportionately draining resources from the health budget.
  • OVER RELIANCE ON PRIVATE SECTOR
  • Indians spent eight times more on private hospitals compared to costs in government hospitals, according to the National Health Accounts (NHA) Estimates for the financial year 2013-14. 
  • Public spending is abysmally low, constituting around 29 per cent of the total health expenditure — ie,1 per cent of GDP.
  • Unnecessary medical procedure
  • Limits the reach of the scheme (Urban Bias): Scheduled Tribe and rural households are typically missed out.
  • OTHER FACTORS
  • Affordable housing, planned urban development, pollution control and road safety are vital for reducing the public health burden. 

SUGGESTIONS?

  • DECENTRALISED APPROACH: OPTIONS TO CUSTOMISE ACCORDING TO THE NEEDS OF A COMMUNITY.
  • To align the local community’s interest with health insurance coverage, the packages must be context-relevant, based on community involvement and the model of “have a say before you pay”, that is, community voice on setting local priorities, paid for by contributions of the members.
  • STRENGTHEN PRIMARY CARE AND ADDRESS THE DEFICIENCY OF DOCTORS IN PRIMARY CARE.
  • STRONGLY REGULATE THE PRIVATE SECTOR
  • Properly defining the cost of procedures
  • Regular monitoring.
  • STRENGTHEN PUBLIC HEALTH SYSTEM
  • Preventive Care
  • Community Health.