Finance minister Arun Jaitley had on February 1 unveiled National Health Protection Scheme, under Ayushman Bharat Programme. National Health Protection Scheme (NHPS) is acclaimed as the world’s largest government-funded healthcare programme, with a target to cover over 10 crore households (or approximately 50 crore beneficiaries) across the country, constituting 40% of total population on the basis of “deprivation and occupational criteria” as per Socio-Economic and Caste Census (SECC) data, 2011.

National Health Protection Scheme is a Centrally Sponsored Scheme with ratio of contribution towards premium being divided between Centre and State (in all states and UTs with legislature) in a 60:40 ratio, in 90:10 ratio between Centre and northeastern states & 3 Himalayan states and 100% Centre’s contribution in case of union territories (UTs) without legislature.

The programme will subsume the two on-going centrally sponsored schemes – the Rashtriya Bima Yojana and the Senior Citizen Health Insurance Scheme. That being said it is not going to be easy for the government to address some of the hurdles that are in the way of smooth implementation of National Health Protection Scheme.

Out of pocket expenditure

National Health Protection Scheme have been launched at a time when a recent report by World Bank shows that, Indians pay about 62 percent of the health expenditure out of their pocket, which is much higher than BRICS nations like China at 32 percent and Brazil at 25.5 percent. While the aim of NHPS is to make healthcare affordable and expand healthcare coverage, concerns have been raised about the premium amount as well, stating that an amount of approximately Rs 1100 per family for a sum assured of Rs 5 lakh may be inadequate. While an initial corpus of Rs. 2000 crore has been announced rest will be funded from 1% additional cess.

Puzzling criteria

One of the major issue in the implementation of National Health Protection Scheme will be the identification of beneficiaries under the scheme. As it will be extremely challenging as criteria and anything other than family income, will cause a huge discontent. The government aims to use Aadhar based authentication for validation of beneficiaries, but linking SECC data to Aadhar to ensure delivery of services is in itself a daunting task, as it is difficult to differentiate between churning poor who regularly move in an out of poverty like small farmers and season workers and occasionally poor who are rich most of the time but may sometimes have a patch of bad luck.

Primary healthcare still unaddressed

Ignoring the primary healthcare is also a major point of concern as Rural Health Statistics 2016 shows the number of primary and community health centres have stagnated over the last three decades and scheme might further promote unnecessary tertiarization of healthcare, leading to a cost spiral. While the past experience from the evaluation of Rashtriya Swasthya Bima Yojna (RSBY) shows that India lacks the institutional expertise and capacity to implement public health insurance effectively. And current public health infrastructure in rural areas like hospital beds, doctors (mainly specialists), healthcare staff, diagnostic facilities, pharmacies, etc are not enough to meet the needs of the population.

Unethical medical practices and frauds

Under the previous schemes for quick monetary gains through unnecessary hospitalization, an extension of hospital stay has been reported. Also, Hospital and Insurance company were found in unholy nexus by charging extra for registration, diagnostics & treatment and claiming false insurance claims by floating ghost beneficiaries under government insurance schemes. Addressing these issues will be tricky.

Alternative for taking healthcare towards universal coverage

One way of increasing the health coverage could be by expanding the scope to achieve Ayushman Bharat by sharing expenditure on outpatient services for a long duration
chronic disease like tuberculosis. Apart from that, each state must be given the flexibility to curate its own list of medical procedures and cost associated with it. Integrating primary healthcare into NHPS will make the scheme more viable and sustainable.

Steps should be taken to make preventive healthcare an integral part of National Health Protection Scheme to reduce the burden of hospitalization caused by disease progression and improving nutritional status, awareness, and maintaining efficient health surveillance systems. Modern IT like Blockchain technology can be used to develop a seamless patient electronic medical record (EMRs) for insurance-based National Health Protection Scheme to prevent fraud and ensure accountability and traceability.

While National Health Protection Scheme is still a in a nascent stage and Prime Minister himself is reviewing the implementation progress, it is important for the implementation agencies to ensure that timely audits are conducted to make this scheme a success and achieve universal healthcare by 2022.

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