The Government of India has announced a massive Health Scheme for the downtrodden people of India called the Ayushman Bharat National Protection Scheme to be launched from August 15 this year- 2018.
This is hailed as the biggest Health Insurance Scheme in the entire world, as it will cover 10 crore families- taking 5 people per family, about 50 crores people- nearly 40% of the total population of the country. The protection is Rs 5 lacs per family in the event of death and disability- total or partial. This Scheme targets deprived rural families and identified occupational categories of urban workers’ families- roughly 8 crores in the rural and 2 crores families in the urban India. For catering to the needs of these people, the Government of India will set up 150000 Health and Welfare Centres.
The Premium Structure
The Government through the Niti Aayog- the topmost Planning Forum of India- has calculated the annual premium per family as Rs 1082 roughly. The Government has set apart a premium contribution of Rs 1500 per family. The remaining part of the premium will be paid by the respective State Government. This is around 60% for the Central Government and 40% for the State Government.
The Benefits
This Scheme covers the following-
- Hospitalisation expenses
- Day-care surgeries
- Follow-up Care
- Pre and Post hospitalisation expenses
- New born child/children expenses
- 22 Specialities including Cardiology, Oncology, Ophthalmology, ENT, Dental and 1341 packages of different Procedures.
- NHPS will offer common treatments such as Coronary By Pass, Knee transplant and the Caesarian Section at a rate which is around 20% less than the rates at the Central Government Health Scheme- CGHS.
- The Government Health Ministry has finalised rates for 1354 Packages covered under the Scheme including Paediatric surgeries, Cancer treatments and Mental Disorders.
The Nitty-Gritties
The State Government may opt for formation of a Trust to unveil this Health Scheme.
This Trust will perform the role of an Insurance Company.
The Government will float a Tender for calling the competitive rates for running the Scheme from the Insurance Companies including the Public Sector Corporations. The Lowest Bidder will be selected for the running of the Scheme. The premium rates may differ from State to State depending upon their rural and urban population as well as their occupations, Life Expectancy, life styles etc. The Insurance Expert the CMD of the New India Insurance Company expects the average annual premium across the country to be about Rs 2500. The Government of India has not calculated the total cost of the Scheme.
The Role of the Hospitals
The Government has the responsibility to involve all the major Government Hospitals as well as the Private Hospitals as a Scheme of this great proportion can not be run by the Government Hospitals alone. All these are to be empanelled by the Government under a common agreed Package rates for different Procedures. There are discussions going on to be arrived at the rates, which should be economical for the consumer, slightly beneficial for the Hospital and at the same time quality-based. No Hospital would like to lose money by handholding in this Scheme although the needs of this vast country stand high in the minds of one and all.
The present position of the hospital beds is also to be taken into account for the success of this Scheme.
India’s infrastructure facilities come to 0.8 hospital beds per 1000 population is quite low compared to the Asian average of 3.3 beds per 1000- Organisation for Economic Cooperation and Development.
The Experience to be shared
If the claim experience under the Scheme is less than 85%, the Insurers can retain a maximum of 15% of the unclaimed amount and refund the balance premium to the Government.
If the claim experience is bad- say more than 100%- the Government will initiate steps for the increase in premium in due course so that ultimately no one loses in the bargain.
Life Expectancy across the World for General Interest
These are the Leading countries in the Life Expectancy 2018-
- Hong Kong- 84.3
- Japan- 83.8
- Italy- 83.5
- Spain- 83.4
- Switzerland- 83.2
- Iceland- 82.9
- France- 82.7
- Singapore- 82.6.
Let us hope that this Scheme will be the Harbinger of Health in our country.
Author
R Venugopal
Retired Executive Director of LIC of India
