The Niti Aayog is working towards a launch on Independence Day of the government’s latest flagship National Health Protection Scheme, which was announced in the Union Budget Thursday. Top officials in the Aayog said that Gandhi Jayanti, on October 2, was the “upper limit” deadline for the formal launch while the fullscale rollout, subject to the pace of work by states, is expected to take place in about one-and-a-half years. Consultations with states are expected to start next week.
“Gandhi Jayanti is the latest by which the scheme will be launched. We, in fact, are working towards an Independence Day launch. We are ready. Work has been going on for very long now,” said Niti Aayog member (health) Dr V K Paul.
The ambitious scheme aims to cover over 10 crore “poor and vulnerable” families — an estimated 50 crore individual beneficiaries — with coverage of up to Rs 5 lakh per family per year.
According to the Aayog’s projections, based on actuarial calculations, the premium for each family is likely to be between Rs 1,000-1,200 with the annual cost of the scheme in the range of Rs 12,000 crore. The tentative timelines drawn up are likely to get approvals from the Union Cabinet and the Expenditure Finance Committee by March, when the stakeholder consultations will take place. The tender’s deadline would be July.
According to projections, the expected coverage to be achieved in the first year is 50 per cent, and the money required around Rs 5,000-6,000 crore. So far, Rs 2,000 crore have been sanctioned.
Health Minister J P Nadda and Niti Aayog CEO Amitabh Kant said resources would not be an issue, especially with the announcement of a health and education cess that would bring in an additional Rs 11,000 crore according to Finance Minister Arun Jaitley. Kant said the real challenge was not resources but implementation.
Basing its calculations on the Rashtriya Swasthya Bima Yojana (RSBY), a successful insurance-based scheme for migrant workers, the Aayog has arrived at a premium amount of Rs 1,082 per family. This figure is based on the fact that for every RSBY beneficiary entitled to a maximum cover of Rs 30,000, the government pays a premium of Rs 500. There is no cap on family size in the proposed NHPS.
Asked about the NHPS format, Dr Paul said: “We are keen on a trust but because it is a federal structure and many states are already running their own health protection schemes, it is the prerogative of the states to decide whether the scheme will be trust-based or insurance-based.”
The proposal being worked out has safeguards for both formats.
For instance, insurance companies cannot make a profit of more than 20 per cent in administrative and other costs. Moreover, if there is a delay in payment by the company or a trust, there is a provision for payment of daily interest.
Although there are misgivings about insurance-based models, the RSBY, which falls in this category, is regarded as a success while the trust-based CGHS has seen an exodus of private hospitals because of delay in payment.
The modality is crucial because estimates of the scheme’s expenses are based on the assumption that it will be solely insurance-based. Currently, the 24 state governments that run health protection schemes use various models involving varying premiums paid by the government for coverage and the maximum cover provided.
Dispelling concerns about the scheme benefitting the private sector, Aayog director Dinesh Arora cited the example of Kerala where 55 per cent of money is being ploughed back into public sector institutions.
“It is about the public and the private sector competing for patients. Money will go to wherever patients go and patients will go where there is good service,” said Arora, a former health secretary in Kerala.
Incidentally, while the Budget announcement on NHPS came along with a Rs 1,200 crore preventive healthcare plan as part of a new programme called Ayushman Bharat, Nadda referred to this as NamoCare, inspired apparently by the Obamacare initiative in the US.
For the other component of Ayushman Bharat — the scheme for health and wellness centres — the Niti Aayog talks about centres being led not by doctors, given the dearth of trained practitioners, but by bridge course-qualified Ayush practitioners or nurse practitioners.
The issue of a bridge course that would allow practitioners of alternative medicine to practice allopathy is currently under the scrutiny of the Parliamentary standing committee of health and family welfare.