Health Insurance Scheme by Government of India
Ayushman Bharat is India’s Ambitious Affordable, Universal Healthcare Program that was announced in the 2018 Budget speech by Finance Minister Arun Jaitley . I thought of sharing my views on this scheme, based on my experience with a similar program (Rashtriya Swasth Bima Yojana or RSBY) and as a past consultant with the Ministry of Health, Government of India.
Staggering Scale and Potential Impact
The announcement of Ayushman Bharat has created excitement among insurance companies and the Indian media.The scale of this proposed scheme is staggering: it will cover around 10 crore “vulnerable” families – that is 100 million families or nearly half a Billion people! This could become the world’s largest healthcare scheme, under which about 40 percent of India’s population will receive health coverage of INR to Rs 5 lakh per family per year (USD 7,600 per year) for secondary and tertiary hospitalization.
The annual premium for each family would be in the range of Rs 1,000-1,200 per family (USD 15-18 per family per year). The premium will be borne by the government: 60 percent of the cost of this scheme would be pair by the Centre while state governments would pay the remaining 40 percent.
This program is important not only for its size and scope but also for the impact it can create. I had written In a previous post about the need for Universal Health Insuranceand the role it plays in poverty reduction: Globally, at least a billion people suffer each year because they cannot obtain the health services they need. In addition, about 150 million of the people who do use health services are subjected to financial catastrophe annually, and nearly 100 million are pushed below the poverty line as a result of paying for the services they receive.
Will Ayushman Bharat achieve Universal Health Coverage?
India has supported the idea of “health for all” since independence but has not been able to make much progress in that direction. The first step towards “health for all” was the National Rural Health Mission(NRHM) which was started in 2005. It is now a part of National Health Mission (NHM), which aims to address the healthcare needs and strengthening the healthcare system of the undeserved rural areas.
I remember when Rashtriya Swastha Bima Yojana was launched in early 2008 (nearly a decade back)there was a lot of talk about this first step taken by India towards affordable healthcare. However, nobody knew exactly the implementation aspect. Back then, I was a part of the Insurance team who was assigned 3 districts in Gujarat. Enrollment of the people under this scheme was a huge challenge. This was an era when smartphones and Aadhaar did not exist, and Internet coverage in rural areas was very poor.
We had set up a team of people in those districts who would work with the Non Government Organizations (NGOs) in that district to facilitate the enrollment. As a typical start up which faces teething issues , we went through the complete ordeal of enrollment, issuance of cards, claims processing etc. It took close to 2 years to stabilize for the processes to be set.
RSBY has come a long way since then and today the smart cards have been issued close to 3.6 Crore (36 million) people. These smart cards are like e-wallets, where the cards come with preloaded sum insured for 3 years. If any person opts for a higher sum insured, they can do so by paying an additional premium. The smartcard has addressed common administrative challenges related to patient verification and processing of claims.
10 Things to look for when implementing Ayushman Bharat
In the last 10 years, lot of changes have happened in terms of technology upgradation in India. With Aadhar being made mandatory, the data of BPL people should be easily available with the Government of India.
Instead of separate smart cards, Cashless Aadhar linked facility with beneficiaries availing treatment anywhere in the country in empaneled Private or Public Hospital should be implemented.
Here are the Top Ten things that could make the Ayushman Bharat insurance program a success:
- In India, health insurance is fragmented as there are certain central health sector schemes as well as state health sector schemes too which overlap in many ways.
- Duplication should be avoided as it leads to unnecessary increase in cost and resources.
- Government should fix the package rates for the hospitals for a large number of interventions which will help to reduce the overall claims cost.
- The scheme has to be designed as a business model for a social sector scheme with incentives built for each stakeholder like Insurance companies, hospitals, and intermediaries like NGOs etc. This business model design is conducive both in terms of expansion of the scheme as well as for its long run sustainability.
- Information technology will play a big role in implementation of the scheme and hence robust technologies should be put in place.
- India has the highest medical inflation cost and close to 100 million people are pushed below poverty line due to this. Majority of the cost is related to out patient treatment and hence eventually steps should be taken to cover OPD treatment too in that 5 lakh sum insured apart from Inpatient Treatment (IPD).
- Possession of a smartcard or enrollment may not guarantee that people are actually receiving care, or that the most cost-effective care . Moreover, looking into the size of the scheme, certain amount of fraud would also emerge. Hence the government should design a quality management system which will be responsible for regular auditing and evaluation of the scheme and whether it is implemented properly.
- Punitive measures against those service providers who do not adhere to the standards as well as indulge in fraud.
- The focus should not be only curing the illness but overall preventative healthcare and Mobile phone technology can play an important role as an enabler for preventative health as well as monitoring the health parameters that can help in early detection and prevention of ailments.
- Tie up with incubators/startups who are working towards bringing innovations in the healthcare space.
- Last but the most important, strengthening of existing infrastructure as well as focusing on skilled manpower will be of paramount importance in order to make this scheme a success.
As Universal Health Coverage has a direct impact on the productivity of the citizens as better health care leads to better lives and less financial loss a holistic approach should be followed to address affordable health care.
*Note: I had written a post titled 10 Things To Look For While Implementing Ayushmaan Bharat a few months ago? You can read my post on LinkedIn here.
Image Credit: Pixabay.You can also read more about RSBY on Wikipedia