AYUSHMAN BHARAT OR NHPS

INTRODUCTION

Prime Minister Narendra Modi announced his flagship project, Ayushman Bharat or National
Health Protection Scheme on Independence Day. The project was on September 25, on the birth
annivarsary of Deen Dayal Upadhyay. Dubbed by ministers and BJP leaders as ‘Modicare’, the
full roll-out of the scheme is expected to be announced from September 25 onwards. The policy
was initially announced by the then finance minister Arun Jaitley in February this year during the
presentation of last full budget of the NDA government.

It has two components namely-

A. HEALTH AND WELLNESS CENTRE[HWC]
HWC'S will be upgraded form of primary health centres[PHC].the focus area includes non
communicable diseases and infectious diseases along with neonatal and maternal care.HWC are
primarily meant for early detection and prevention. This is significant in sense as burden on
secondary and tertiary health system will reduce if early detection takes place, moreover rural
areas will benefit as HWC will spread across India.

B. NATIONAL HEALTH PROTECTION SCHEME[NHPS]

NHPS is an insurance scheme which covers costing up to 5 lakh rupees per family per year for
secondary and tertiary care hospitalization. It will cover 10 crores poor and vulnerable families.
The scheme will reduce out of pocket expenditure and offers a choice for treatment at private
hospitals.

Strategy of Scheme
 Establishment of Ayushman Bharat National Health Protection Mission Agency at
National Level and State Health Agency to ensure proper implementation of Scheme at
National,State and UT levels.
  The States and UTs can implement scheme through an insurance company or Directly
through Trust/Society. This would increase Ambit of the Scheme at Ground levels.

Merits of Scheme
 A Strong Network of 1.5 Lakhs Health and Wellness Centers across the Country would
constitute Foundation of India's new Healthcare Systems.
 It will cover more than 10 Crore Poor and Vulnerable Families of the Society.
 The Support from Trained Nurses and Health Workers increase the Availability near
Home in Rural Areas.
 Vulnerable Sections of the Society would have access to Healthcare to almost all medical
and Surgical Conditions that can occur in Lifetime.
 Package Rates decided by Government for Private Hospitals would help in keeping the
cost low.
 It will generate Employment Especially for Women would help in Economic
Empowerment of Women.

Challenges
 Major Challenge would be Implementation and Governance of the Scheme.
 The private hospitals are based on profitability motives and fixing rates of procedures
would increase chances of hospitals neglecting poor Patients. The Healthcare is a goal
under SDG 2030 Goal-3 of good health. The scheme would ensure proper healthcare
facilities for most vulnerable sections of the society.
 By preventive disease at early stage can make a change.For example, early detection of
diabetes at the age of 35 can avoid the kidney failure at age of 50.Also schemes exclude
outpatient health care that is responsible for 70% of health expenditure.
 Budget allocation of 2000 crore scheme doesn't serve the purpose.Amount is meager as
compared to scope of the scheme.
 The schemes is far from universal health coverage as it exclude 80 crore (60%) of the
population.
Way forward
Providing insurance covers alone will not improve the health system in the country.Rather, there
is a need to build robust health care infrastructure in the remotest corners of the country where
people have easy access. Budget allocation needs to be increased to realize the purpose of the
scheme.

What is Ayushman Bharat or National Health Protection Scheme?

The ambitious Ayushman Bharat or National Health Protection Scheme aims to cover over 10
crore vulnerable families (approximately 50 crore beneficiaries) and provide health cover up to
Rs 5 lakh per family per year. The programme is being touted as the world’s largest health
protection scheme. The benefits of the scheme are 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.

Who are covered under Ayushman Bharat or NHPS?

The scheme will aim to target over 10 crore families based on SECC (Socio-Economic Caste
Census) database. To ensure that nobody from the vulnerable group is left out of the benefit
cover, there will be no cap on family size and age in ‘Ayushman Bharat’ scheme. The insurance
scheme will cover pre and post-hospitalisation expenses.

How will the finances of Ayushman Bharat be covered?

The expenditure incurred in premium payment will be shared between Central and State
Governments in a specified ratio. The funding for the scheme will be shared – 60:40 for all states
and UTs with their own legislature, 90:10 in Northeast states and the three Himalayan states of
Jammu and Kashmir, Himachal and Uttarakhand and 100% Central funding for UTs without
legislature. The states are also free to continue with their own health programmes.
So far, 14 states have finalised their memoranda of understanding with the Centre. Of these
Andhra Pradesh, Telangana, Madhya Pradesh, Assam, Sikkim and Chandigarh are the states that
will use a trust model for the mission. In a trust model, bills are reimbursed directly by the
government. Gujarat and Tamil Nadu have opted for mixed mode implementation. In an
insurance model, the government pays a fixed premium to an insurance company, which pays the
hospitals.

Who are Covered?

1. The National health Agency headed by a full time CEO will be the nodal agency
for the implementation of the programme. States and Union Territories will devise
their own modes of implementation – the one suggested by the Centre as a model
is through state health agencies (SHA). They can use either an existing trust or
society or not for profit company or a state nodal agency or can set up a new
entity.
2. Like in case of the National Health Mission, responsibility for the
implementation of NHPM will lie with the states. It is their call whether they
choose to implement through a trust model, an insurance model or in the mixed
mode.
3. Right from the beginning, the issue of branding for the mission – that has been
lovingly referred to as Modicare by ministers and BJP functionaries – has been a
thorny one. That is why a “consensus “ was reached that for states that already
have a health scheme running, AB-NHPM would enter the state as an “alliance”
with the state programme. So in Telangana, Ayushman Bharat will be in alliance
with Aarogyashri, in Tamil Nadu, it will be in alliance with the Chief Minister’s
Comprehensive Health Insurance Scheme and in Maharashtra it will be in alliance
with the Mahatma Jyotiba Phule Jan Arogya Yojana.

4. The funding for the scheme will be shared – 60:40 for all states and UTs with
their own legislature, 90:10 in NE states and the three Himalayan states of Jammu
and Kashmir, Himachal and Uttarakhand and 100% Central funding for UTs
without legislature.
 5. The states are also free to continue with their own health programmes. That would
take care of the concerns of states like Maharashtra about the existing beneficiary
list already being bigger than what the SECC data entails. The “dovetailing”
means that if as per SECC data, 2 lakh people in the state are covered by NHPM,
while the state scheme already has 3 lakh people, the Centre would pay 60% of
the premium amount for 2 lakh people. For the state it would mean some savings.
For states particularly ambitious and willing to pay it is even possible for them to
make the beneficiary base additive, at least theoretically. It also means that
Naveen Patnaik has not only stolen the Centre of bragging rights by announcing a
Rs 5 lakh health scheme, a time may soon come when 60% of that premium
amount is paid by the Centre.
6. There will be 100% portability within the country. Package rates of the hospital
where benefits are being provided will be applicable while payment will be done
by the insurance company that is covering the beneficiary under its policy. State
Governments will enter into arrangement with all other States that are
implementing AB-NHPM for allowing sharing of network hospitals, transfer of
claim & transaction data arising in areas beyond the service area.

AIMS AND IMPLEMENTATION

The Ayushman Bharat programme is apparently driven by two main aims: 1) to strengthen
primary health care which has been lacking in the country and 2) to offer finacial
protection from catastrophic expenditure, often encountered once a family member is sick
and needs long-term health care.

Implementation is Key
1. The scheme, if implemented properly could be a game changer by enhancing
access to health re including early detection and treatment services by a large
section of society who otherwise could not afford them. The identification of
beneficiaries can be done by linking with Aadhar and similarly following up for
 services received and health outcomes achieved, thereby helping to monitor and
evaluate the impact of the programme.
2. Ultimately, NHPS could help country move towards universal health coverage
and equitable access to healthcare which is one of the UN Sustainable
Development Goals or SDGs.This new scheme builds on the already existing
Rashtriya Swasthya Bima Yojna or RSBY – a health insurance scheme for the
below poverty line families, with entitlement of upto Rs 30,000 per annum for
diseases requiring hospitalization. However, given that states are expected to
agree for 40 per cent share under the NHPS and that health being a state subject,
state ownership and commitment will be critical for the success of the
programme.
3. The Finance Minister has made a budget allocation at Rs 52,800 crores for the
health ministry, up from Rs 47,352 crore during the previous year signifying an
increase of 11%, yet as percentage of the GDP, it is still among the lowest in the
world. In addition, government plans increase the levy of health cess from 3 to
4%. According to health minister J P Nadda, Rs 2000 crore has been allocated as
of now.
4. It is clear that the NHPS scheme, which primarily offers support for clinical
services such as hospitalization, is unlikely to help fix the broken public health
system in the country. The most critical issue remains the limited and uneven
distribution of human resources at various levels of health services, with up to 40
per cent of health worker posts lying vacant in some states. Most primary health
care centres suffer from perennial shortage of doctors and even district hospitals
are without specialists.
5. Without addressing the human resouce situation, public sector health care will
remain of poor quality and largely unacceptable, forcing patients to go to the
private sector. Therefore, it seems as if NHPS is likely to benefit private parties
more than government health services. This will ultimately be unsustainable and
even detrimental for the poor for whom the scheme is intended.
6. To maximise benefits, it may be wise to establish a link among various health
initiatives announced in the budget and also with related programmes such as the
National Health Mission.
7. Clarity is also needed on what services will be provided by government health
facilities and for which conditions patients will have to use private parties and
what mechanisms are being thought of. There is a need for uniformly pricing
systems for various health interventions, including diagnostics and medicines, and
making them transparent by displaying them in hospital premises.
8. Moreover, a continuum of care system also needs to be established by linking
institutions or hospitals, with health centres and the community. Community
engagement is thus crucial in planning and implementation of the programme and
in ensuring that the health and wellness centres and the primary health centres are
responsive to the needs of the community.
For the success of the programme, effective implementation is the key.
9. Finally, the scheme is innovative and path-breaking in the history of public health
in India, which may have a transformative impact if implemented in an effective
and coordinated manner. The enduring interest and level of discussion in the
media does reflect the wider realization in the country that only healthy people
can build a strong and prosperous nation.