Ayushman Bharat-National Health Protection Mission to be Rolled Out on September 25; What Can be Key Challenges Before Pradhan Mantri Jan Arogya Abhiyaan? 

Prime Minister Narendra Modi today announced from the ramparts of the Red Fort that the pilot projects of the scheme will start testing waters across the country in next 3-4 weeks.

Prime Minister Narendra Modi today announced from the ramparts of the Red Fort that Pradhan Mantri Jan Arogya Abhiyaan will roll out on a pilot basis in next 3-4 weeks in few states. The government-sponsored health insurance scheme- Ayushman Bharat – National Health Protection Mission (AB-NHPM) – will be launched on a full-scale basis on September 25 2018, covering hospitalisation cost of 10 crore poor families, comprising 40 per cent of the population, which is in other words will be equivalent to the combined population of the US, Mexico and Canada.

This is a big initiative by the Modi government considering more than 80 per cent of healthcare needs of Indians are met by out-of-pocket expenditure. Lakhs of families every year go back into poverty due to the high cost of medical care in the country. The Rs 5 lakh cover offered under the Ayushman Bharat scheme will certainly help poor families in meeting their healthcare needs.

Prior to Pradhan Mantri Jan Arogya Abhiyaan, the UPA government launched Rashtriya Swasthya Bima Yojana (RSBY). The sum insured under the policy was, however, just Rs 30,000. It, however, created a landmark by setting up an infrastructure for cashless settlement of hospital bills by use of Smart Cards. Moreover, one needed to pay just Rs 30 for getting the medical care.

PM Narendra Modi, however, has not declared yet what will be the premium under AB-NHPM. How much of it will be funded by the central government and state, and will some burden fall on the common man, too. There have been reports that the premium could be around Rs 1,000 for the scheme. It has to be seen how the entire scheme will be funded.

According to the government website, the actual premium has to be discovered through an open tendering process or the maximum ceiling of the premium to be decided by the government, whichever is less and this would be shared between central and state governments as per the extant directives issued by Ministry of Finance. The existing sharing pattern ratio is 60:40 between the central and states government.

Most importantly, it has to be seen how the scheme will work. So, far insurance companies have not shown much keenness in participating in the scheme given low premium and high insurance cover offered under the scheme. Some private insurers have confirmed that they will not even participate in the scheme given the bad experience they had while execution of RSBY.

Another concern is about the coverage of outpatient costs, as more than 60 per cent of all out-of-pocket expenditure on health relates to outpatient costs. The inclusion of outpatient cost will, therefore, be a critical factor.

Having said that many state governments, such as Aarogyasri in Andhra Pradesh and Comprehensive Health Insurance Scheme in Kerala, are already running their health insurance scheme, successfully. Will the integration with AB-NHPM disrupt their existing schemes?

As the scheme will start rolling out in next 3-4 weeks on a pilot basis, it will be clear how promising Pradhan Mantri Jan Arogya Abhiyaan will prove for poor and downtrodden families of the country.

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