The Maharashtra government will launch the National Health Protection Scheme (NHPS) across the state on September 25 with the health department opting for a hybrid model, combining insurance and trust models, to implement the scheme for over 83 lakh beneficiaries. The launch date coincides with Jana Sangh co-founder Pandit Deendayal Upadhyay’s birth anniversary. The latest scheme is expected to add a burden of Rs 500 crore for the state government. Maharashtra will join Gujarat and Chattisgarh that have opted for a hybrid model to launch the BJP government’s scheme. Rajasthan, Nagaland and West Bengal are contemplating launching the hybrid model for the scheme.
NHPS was announced in this year’s Union Budget speech to benefit 10.74 crore families with medical insurance cover of Rs 5 lakh each. Senior government officials told The Indian Express that the NHPS will run along with the state’s existing health insurance scheme, Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). But initially, the scheme will be implemented in a slow pace to assess the impact. The Yojana currently covers 2.25 crore people in the state, providing medical insurance up to Rs 1.5 lakh in 492 empanelled hospitals.
Under the latest NHPS, patients undergoing treatment of less than Rs 1.5 lakh will be categorised under MJPJAY, while the beneficiary pool of 83 lakh population requiring treatment between Rs 1.5 lakh and Rs 5 lakh will be aided through a trust model set up by the state government. The state plans to use biometric scans to register patients. On Friday, a meeting was held with the Principal Secretary (Health), Dr Pradeep Vyas, to finalise the list of surgeries that patients in Maharashtra can avail of under the new scheme.
Currently, MJPJAY provides coverage of 971 procedures, while the NHPM, announced as part of Ayushman Bharat by the Union Health Ministry, will cover more than 1,300 procedures. State officials claim that initially, Maharashtra will not cover all 1,300 procedures. “Procedures finalised and not part of the 971 already listed in the state scheme will be funded through the trust mode,” a senior official said.
Surgeries like caesarean procedure may be kept out of the ambit, while the government is still mulling over organ transplants, hip and knee replacement procedures. “Caesarean surgeries are conducted for free in government hospitals. We do not need insurance for those. For knee and hip replacement procedures, stringent criteria of age and medical condition will be formed to provide benefit to only the most needy patients,” the official said. The government hopes to implement the trust model to fund total knee and hip replacement procedures. A good quality implant can cost about Rs 1 lakh.
The state officials are set to conduct meetings in Delhi to discuss the scheme with the Union Health Ministry. The contract for the existing MJPJAY scheme will end in December this year. Currently, the Maharashtra government pays a premium of Rs 690 per family to insurance company for 971 procedures. After December, revised tenders may escalate the premium amount if the government decides to increase the number of procedures as part of expanding the NHPS.
The MJPJAY costs the Maharashtra government Rs 1,571 crore annually. Data from the state government indicates that about 1,000 patients enrol under MJPJAY every day while annually, 3.5 lakh surgeries are conducted across the state. Uttar Pradesh, Himachal Pradesh, Tripura and Uttarakhand are some of the states that have decided to opt for the trust model to aid medical treatment instead of the insurance model.