The National Health Protection Scheme (NHPS), which aims to provide health cover to 100 million poor families, is one of the most significant
announcements of the Union budget 2018-19. Finance minister Arun Jaitley termed the scheme Modicare, on the lines of Obamacare, the universal health insurance plan introduced in the US during Barack Obama’s presidency.
Few, however, know that Dr Vinod Kumar Paul, member (health and nutrition) at the country’s apex policy think tank NITI Aayog, led the team that designed the world’s largest government funded financial protection scheme for healthcare that will cover as many as 500 million Indians. In an interview, Dr Paul comments on how the idea for this ambitious programme came about and how the project is going to be implemented in a country that has a dismal record of healthcare delivery. Edited excerpts:
What was the ideology behind planning the NHPS? What factors were taken into consideration while charting out this programme?
There are basically two pillars of Ayushman Bharat programme under which we are bringing reforms in the healthcare system. One is strengthening our primary healthcare foundation; second is financial health protection for the citizens. The two components of Ayushman Bharat are interlinked. Till now the existing sub-centres are catering to only maternal and child healthcare services but the 1.5 lakh sub-centres that we are converting into wellness centres will cater to majority of services such as detection and treatment of hypertension, diabetes, chronic bronchitis, screening for common cancers, mental health, care of the elderly, eye care, etc. We have added all these things into primary healthcare. Financial health protection is the foundation of any nation’s healthcare policy. Through the National Health Protection Scheme, we will reduce impoverishment due to out of pocket health spending and want to take healthcare in India to the next level by covering the poor and vulnerable 40% of the Indian population by this aspirational model. It is a decisive step toward the goal of universal health coverage.
Health insurance schemes in India have seen little success, barring a few states in the south, how do you think this programme is going to fair?
First of all, this is not just a health insurance scheme but this is a health assurance scheme for Indians. As health is a state subject, this will be implemented by states and with their own choice. The states will be a custodian of this scheme. Some states can choose an intermediary to implement it such as an insurance company while some may try a trust model in which there will be an autonomous body under the government that will bear all the expenditure. This is a tax-funded scheme.
What are the details and timeline of the programme?
This scheme is about covering expenses of hospitalization for secondary and tertiary care. In India, out-of-pocket expenditure is over 60% which is one of the highest in the world. Around 6-7 crore people fall into poverty each year due to medical expenses and they are often the non-poor. This one nation, one scheme, will give coverage of Rs5 lakh to 10 crore poor and vulnerable families which means about 50 crore people in India. This will be a cashless, Aadhaar-enabled scheme with 60:40 centre and state share. As far as tentative timeline of the scheme is concerned, the scheme will be finalized after further consultations with state governments, preparation for fraud-proof information system, states’ preparation for beneficiary identification, after finalization of guidelines for hospital empanelment and strategic purchase. As soon as the states are ready, the scheme will be rolled out.
As projected, the implementation of the programme will require Rs12,000 crore for the first phase for 10 crore families. Do you think the India as one of the economies spending least on healthcare i.e. below 2% of GDP, will able to handle the huge costs involved?
As government has given the policy direction, it will fulfil its promise of provisioning adequate funds. I agree that the expenditure on healthcare in India is too less but we have made provisions for a cess that will generate additional Rs11,000 crore. As envisaged in the National Health Policy, the government will incrementally increase the health expenditure to 2.5% of GDP by 2025. Ayushman Bharat represents the resolve of government to transform the health system in order to ensure that people of India experience good health, live longer, have health lifestyles, and can access quality care without financial hardship if they fall sick. If finance minister Arun Jaitley has promised to provide adequate funds for Ayushman Bharat, we should believe him. State governments will also increase their health budgets when they join the national scheme.
As under the programme, poor and vulnerable people will be entitled to treatment in empaneled central, state government hospitals and selected private hospitals, on what parameters will the private hospitals be selected for empanelment?
The hospitals will be chosen on the basis of a structured criteria including optimum facilities, assurance of patient services, accountability and infrastructure for treatment of diseases. We have prepared the framework for this criteria and selection. Selected state and central government hospitals and selected empanelled private hospitals will come in the scheme’s ambit and will serve the beneficiaries. Thus the scheme will be delivered by a network of public and private hospitals. Private hospitals are also nation’s asset.
What are the diseases covered this time which have never been covered in any national or state health insurance scheme?
The government has already prepared around 1,100 packages for the scheme. There will be certainly several new diseases covered under the new scheme which were earlier not covered under any government health insurance scheme such as dental services, geriatric services and HIV/AIDS etc. We have largely covered almost everything. We hope to cover most of the conditions requiring tertiary and secondary care.
As expected almost 40% of Indian population will be covered for free and cashless healthcare with focus on rural India. How will the country that already has a shortage of doctors handle so many patients?
For tackling the shortage of doctors, the government has already announced opening of 24 new medical colleges. The workforce will be prepared to serve various hospitals. As the concentration of specialist doctors is more in urban areas, we have plans to give more incentives to doctors who serve in rural areas. We also have various training programmes for nurses and paramedical staff who have long experiences working with senior doctors in tackling common diseases conditions and know the righteous medicines and treatment modalities. Such utilisation of resources will be done until the number of doctors can be increased.
Private hospitals have been complaining about delays in payments for treatment provided to patients under government run health insurance scheme – Central Government Health Scheme (CGHS). How will government ensure to avoid such delays and tussles in the new scheme?
We will ensure that such delays and discrepancies don’t happen in NHPS. We will have a proper agency for this purpose to look after smooth flow of money and all the premiums are paid on time