The Cabinet’s approval of Ayushman Bharat – National Health Protection Mission (AB-NHPM) on March 21 officially sets the ball rolling on the implementation of this flagship programme of the Narendra Modi government. August 15, India’s 72nd independence day is rumoured to be the targeted launch date, as the PM had first spoken about a healthcare scheme for families Below the Poverty Line from the ramparts of Red Fort in his 2016 I-Day address. However, Union minister for Health and Family Welfare JP Nadda has said Modicare would be fully functional by October, possibly on the 2nd, which is the birthday of Mahatma Gandhi. As this will be Prime Minister Modi’s last I-day address in this term, the success or failure of AB-NHPM will significantly impact 2019 general elections.
There is no doubt that there is a sense of urgency. Consultations with the directors and key staff of the National Health Missions of the states were held in March itself, both in Delhi as well as in various state capitals. These consultations will continue through April, as Naddaji is set to hold zonal meetings with the states along with his two Ministers of State, Ashwini Kumar Choubey and Anupriya Singh Patel, to fine-tune the system.
The success of the scheme rests on at least four crucial factors. First, a rigorous vetting of the Socio Economic and Caste Census (SECC) data. This needs to be done at the gram panchayat level of every state as the approximately 10 crore beneficiary families will be identified on the decided deprivation categories based on this data. Reports indicate that April 14 has been set as the date for the Health Ministry and the Gram Swaraj Abhiyan of the Rural Development Ministry to carry out this exercise.
The scheme is very well intentioned, intending to cover almost all secondary care and most of tertiary care procedures. Moreover, there will be no cap on family size and age and also include pre and post-hospitalisation expenses, as well as all pre-existing conditions. A release also states that a defined transport allowance per hospitalisation will also be paid to the beneficiary. Adjusting these claims against a defined benefit cover of Rs 5 lakh per family per year, looks like a tall task but at least a start has been made.
According to a timeline shared by Naddaji, April will also see seven working groups sharing operational guidelines, model of the tender and contract, drafted by them with the states. A CEO for the national health agency will be appointed. This is a key post as this agency will anchor the registration and operationalisation of the 1,347 packages, listing diseases and related procedures covered by the scheme.
The second crucial task, therefore is structuring of these packages and deciding costs associated with the treatment. Each state/ UT will be given the flexibility to modify these rates within a limited bandwidth, subsume existing schemes into AB-NHPM as well as choose the mode for implementation, that is through an insurance company, directly through a trust/society or a mix of both models. Approving packages tweaked by states will be a tricky balancing act as all parties have used health schemes to appease votes banks. Thus, AB-NHPM officials will have to tread very carefully if they want their cooperation.
The third crucial aspect is the functioning and monitoring of insurance-based reimbursements, once the scheme is operational. This needs IT infrastructure geared to detect frauds/ misuse even as it aims to be paperless, cashless and portable. Recognising this, the ministry will make pre-authorisation mandatory for certain treatments deemed to have a high potential of misuse, as well as have a grievance redressal mechanism.
Thus, the IT system will be the backbone of AB-NHPM, and one hopes that all safeguards will be put into place. May 30 has been set as the deadline for its design in consultation with NITI Aayog while June will be devoted to test and finalise it. State and district officials are to complete their training in June while states complete awarding of tenders and empanelment of hospitals in the same month.
The fourth crucial aspect is deciding criteria to empanel and monitor private hospitals. All public hospitals in the states implementing AB-NHPM will be deemed empanelled for AB-NHPM while hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on bed-occupancy ratio. The criteria for private hospitals will be crucial to ensure there is no misuse of the system. Implementing AB-NHPM seems like a tall task but nothing ventured, nothing gained seems to be the motto of this government. Let’s hope implementation lives up to intent.
Viveka Roychowdhury
Editor