The Directorate General of Health Services (DGHS) has been asked to draw up a list of procedures/diseases that will be covered under the National Health Protection Scheme (NHPS), in preparation for rollout of the programme. Once the list is finalised, it will be circulated to all states who opt for it, with the provision that states can make marginal changes in the package rates.
The list of conditions/diseases to be covered and the admissible package rates for the proposed cover of Rs 5 lakh for 10 crore families mooted by Finance Minister Arun Jaitley in his Budget speech is crucial for the actual implementation. This is not just because the coverage amount is finite and there is no ceiling proposed in the family size, but also because a balance will have to be struck between including all common conditions based on India’s unique disease burden and procedures that are the most value for money.
For example, whether transplants will be covered or not is a thorny issue that will have to be resolved. While the coverage is too small for the procedure to be done in a private hospital, very few government hospitals in the country have a transplant programme. On the other hand, India’s high hypertension burden leaves many people running the risk of requiring a kidney transplant.
“It is very important to specify not just the conditions that will be covered under the scheme but also the duration of stay, sittings of treatment procedures like dialysis or chemotherapy but also the rates at which these will be covered —- as is done in case of the Central Government Health Scheme. The DGHS is working on a list of procedures and packages. States may be allowed flexibility of 8-10% over the specified rates,” said a source.
Once the rates are finalised, it will be up to the states to choose a mode of implementation —- whether to go for a trust-based option like CGHS or an insurance-based one like Rashtriya Swasthya Bima Yojna —- and also whether they want to subsume existing schemes into NHPS.
Meanwhile, the first responses from states started trickling in ahead of a meeting of state health secretaries on Thursday and Friday to discuss the modalities for NHPS.
West Bengal was the first state to have opted out of the scheme, with Chief Minister Mamata Banerjee saying in Krishnanagar on Tuesday that her state will not shell out the 40 per cent fund required for the programme, as it already has a programme of its own. Uttar Pradesh has expressed willingness to roll out the scheme in the next two months, ahead of the central launch, if the money is forthcoming.
“It is the states’ prerogative whether to take up NHPS or not, because health is a state subject. But we want to make the blueprint foolproof, that is why a lot of thought is going into the list of conditions and package rates. We are eventually looking at a PPP mode of implementation,” the source said.