NEW DELHI: The government has decided that about 1350 packages—that include almost all conditions needing hospitalisations, except for organ transplantation—will be provided through the ambitious Ayushman Bharat- National Health Protection Mission, first announced in the Union budget this year.
The Union cabinet on Wednesday approved a note on the policy outlines of the scheme that aims to provide Rs 5 lakh insurance coverage for about 50 crore or 40 per cent Indians.
Union Minister for Health and Family Welfare said that a “robust” IT system will be put in place by July-end that will give auto alerts whenever there is a malpractice, such as spike in certain kind of surgeries usual rise in in-patient registration, detected.
“This is a bold scheme but we also need to make it mistake-proof and for that we are looking to develop a IT mechanism so that we do not repeat the mistakes made in the past,” Nadda said.
The AB-NHPM is intended to address concerns that in-patient hospitalization expenses in India have increased 300 percent over the past 10 years and nearly 80 percent of this expenditure comes from household’s out-of-pocket spending.
The government is hoping that the the programme will significantly reduce out-of-pocket spending on health by providing the Rs 5 lakh cover to about 10.74 crore families paying for almost all diseases requiring secondary and tertiary care.
“To ensure nobody is left out, there will be no cap on family size and age in the scheme,” a ministry official explained. “The benefit cover will also include pre- and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy. A defined transport allowance per hospitalization will also be paid to the beneficiary.”
Famillies may seek hospitalization services from public and private hospitals anywhere in the country empanelled by the government.
The eligibility critieria will depend on households’ deprivation levels. In rural areas, for instance, families with only one room with “kucha walls and kucha roofs,” families with no adult members between ages 16 to 59, female-headed households with no adult male member between 16 and 59, household with no able-bodied adult members, Scheduled Caste and Scheduled Tribe households, and landless households that derive most of their income from manual casual labour will be covered.
In urban areas, families in 11 occupation categories will be covered in the scheme, the note said. Households without shelter, destitutes and those living on alms, manual scavenger families and primitive tribal groups will also be covered in rural areas.
The Centre is hoping to work with states in implementing the AB-NHPM, but states can expand the scheme at their own cost “horizontally and vertically” and choose their implementation route – either through insurance companies or trusts.
In states where the scheme is implemented through trusts, the Centre’s share of funds will be provided on actual expenditure or premium ceiling in that ratio.
The Centre, in efforts to control the treatment costs, proposes to work out the “package rates” for various treatments, but states will have the flexibility to modify the rates within limited bandwidths.
The AB-NHPM will als replace the Centre’s Rashtriya Swasthya Bima Yojana which provides a cover of Rs 30,000 per family per year and be integrated with the health protection plans already offered by many states.