Published in Indian Express | By Abantika Ghosh| On March 22, 2018
Continuing to focus on healthcare, the Union Cabinet Wednesday approved the organisational architecture of the Ayushman Bharat-National Health Protection Mission (AB-NHPM) that will provide health insurance to 10.74 crore families, and the continuation of the National Health Mission till March 31, 2020, with budgetary support of Rs 85,217 crore.
While the NHPM was announced in the Union Budget this year and aims to provide Rs 5 lakh annual health cover, the NHM was the flagship UPA government programme and will be the principal vehicle for universal health coverage (UHC ).
The Cabinet statement on the NHPM left the crucial question of finances unanswered. Scrutiny of an earlier health cover plan of Rs 1 lakh announced in the 2016 Budget, which was sent to the cabinet but never taken up, could hold the key to that omission.
Preparing for the NHPM rollout last month, when the health ministry met general insurers, it found no takers for its Rs 1,082 annual premium for the health cover plan. At this premium, the annual expenditure is estimated at Rs 10-12,000 crore, which, according to sources, remains the working estimate for the plan. The insurers had asked for a premium of Rs 2,500 in that meeting in Mumbai.
The Rs 2,500 premium is more in line with the government’s own calculations for an earlier health insurance plan, which was buried after the bigger, better version was resurrected. For the Rs 1 lakh health cover plan (with an additional Rs 30,000 top up for senior citizens) the General Insurers’ (Public Sector) Association of India had negotiated with the government a premium of Rs 950 which was incorporated in the final scheme proposal.
Based on that figure, the central and state shares were to be Rs 570 and Rs 380 and the administrative cost for the Centre was calculated at Rs 733 crore including the cost of the National Health Authority, IT systems, and cost of the national family health card.
The total cost for the Centre for five years was estimated at Rs 29,162 crore – about Rs 6,000 crore per year. The present working estimate of Rs 1,082 is just Rs 132 more. The government is now hoping to be able to roll out a scheme with five times more cover at just about double the cost. “The actual estimates will be arrived at when the tendering happens,” said a health ministry official.
Its not only the estimate that is being recast. Between August (Prime Minister Narendra Modi reiterated the Rs 1 lakh NHPS in his 2016 Independence Day speech after it was first announced by Finance Minister Arun Jaitley in his Budget speech) and December 2016, 17 meetings were held and 22 expert groups worked on various aspects of the Rs 1 lakh National Health Protection Scheme (NHPS).
Also, the director general health services had approved 1,339 clinical packages in 22 specialties with pre-authorisation for 548 packages (by an expert panel of doctors) with room for state flexibility. The DGHS is at present engaged in the same exercise for the Rs 5 lakh NHPM all over again.
Among other work that had been completed for the NHPS were the finalisation of the IT blueprint, guidelines for empanelment of hospitals, model tender documents, filtering of Socio-Economic and Caste Census (SECC) data for eight crore people, district action plans and publicity material.
The NHPS only awaited approval by the Union Cabinet, which did not come through till February 2018 – when the scheme was recast.
In January 2017, pilot testing of field validation mobile applications was carried out in Karnataka, Himachal Pradesh, Tripura and Chhattisgarh. A communication agency was engaged around the same time for designing the logo and the NHPS family card fascia.
The NHPM is designed to prevent catastrophic health expenditures. According to government data, in-patient hospitalisation expenditure in India increased nearly 300 per cent in the last ten years. More than 80 per cent of the expenditure is out of pocket (OOP). Out of pocket (OOP) expenditure in India is over 60 per cent which leads to nearly 6 million families falling into poverty due to health expenditures.
The Cabinet Wednesday also approved the continuation of the Prime Minister’s Development Package for Jammu and Kashmir 2015 – “Stepping up of support under the creation of infrastructure in district hospitals, sub-district hospitals and primary health centers over 5 years” – with a budgetary support of Rs 625.20 crore.