Ayushman Bharat : National health protection Scheme : DIscussions

Aravind

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Dec 5, 2017
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Modicare Is Here, And This Is Why It’s Needed


Pro-market governments are typically identified with the interests of the rich capitalists and business owners. A perception has been created worldwide that right-leaning governments only pander to the top 10 per cent of the population while it is the left which concerns itself with “soft” sectors such as health, education and farmer development. In this context, the launch of the world’s biggest health insurance programme by the Narendra Modi government goes against the vein of this compartmentalisation.

It is for the first time in the economic history of independent India that health has emerged as the biggest headline of the budget announcement. For, I do not remember when was the last time that finance gurus on the day of the budget announcement were talking about a subject so seemingly “left”.

Finance Minister Arun Jaitley today (1 February) announced the launch of a new flagship National Health Protection Scheme, which aims to cover nearly 50 crore beneficiaries. This entails a whopping Rs 5 lakh per family per year to cover secondary and tertiary hospitalisation charges.

Let us analyse how this will apply to the Indian context.

Despite an over-reliance on the socialist model of healthcare spending, India offers one of the poorest levels of financial risk protection to its health-seeking citizens. Nearly 67 per cent of what an average Indian spends on healthcare comes out of their own pocket, and less than 30 per cent of their expenses are covered by either government services or insurance cover. If we translate these medical expenses nationwide, every year, nearly six crore Indian households fall below the poverty line only because they are not able to pay for their medical expenses. And a majority of the affected populations are the Dalits, tribals, and those from rural and poor households.

The missing link in this picture is the absence of a comprehensive health insurance model in India. Nearly 86 per cent of rural Indians and 82 per cent of the urban populace are still not covered under any scheme of health expenditure support or insurance system. Though attempts like the Rashtriya Swasthya Bima Yojana were made previously, a systematic effort to provide social security and health insurance cover were missing. It is in this light that the government’s commitment to launch the world’s largest health insurance scheme sets India on the path of progressive universal health insurance.

This is proposed to be complimented by the setting up of over 1.5 lakh health and wellness centres, which will “bring healthcare closer to home”. Keeping in line with the data that nearly 70 per cent of the out-of-pocket expenses in the Indian healthcare industry are on drugs and diagnostics, these centres will primarily focus on the same. Additionally, 24 new government medical colleges and hospitals will be set up by upgrading district hospitals in the country, to ensure that there is one medical college for three parliamentary constituencies.

The right to lead a healthy life is increasingly being recognised the world over as one of the central pillars of human rights and social justice. India’s commitment towards universal health insurance, therefore, seems like the right recipe to balance the market-led growth of the economy with health insurance and financial risk protection.

Dr Ananya Awasthi is Assistant Director, Harvard India Research Centre, Mumbai.
 
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Its very good idea on paper and will save money+time+stress esp if it replaces the cacophony of health initiatives (mostly at state level) that need the BPL ppl to prostate in front of hospital admins and/or district bureaucracy (or just stay home and suffer)....by making using of aadhar and federal legislation. It is sort of DBT but for health insurance....and a basic UHS can take root from it over time as the big data for this priority start flows in....only when the country gets lot more rich and all manner of things are added into the UHS (of questionable social return ratio) does it become a case of massive diminishing returns and fiscal burden....but India is far from that case.....so any federal public health program I will generally support (provided there is means for good targetting, which aadhar provides now).

Remember having a healthy population by good prevention and/or early cure SAVES money for the economy in long term (at the basic health level where social good return ratio is very high).

But we need to watch for the implementation of it.
 
This all good but how will India fund this massive massive health plan?

Please note that I am not against it. I am just wondering how does Indian government plans to fund the massive bill for health plan for half a billion people?

May be by breaking all the Pharma patents?
May be HUGE tax increase is coming our way?
May be massive cut in spending in some other area, say defence?
May be huge debt? More sovereign bonds on the way?

How will they find it is a trillion dollar question. Because even mere 100 dollars per person (Rs 6500) will yield 50 billion dollar bill. Thats more than 10% of government revenue.
 
Modicare Is Here, And This Is Why It’s Needed
by Ananya Awasthi - Feb 01, 2018, 5:52 pm
79SHARES

GettyImages-866687154.jpg
Prime Minister Narendra Modi (Sonu Mehta/Hindustan Times via Getty Images)

Snapshot
  • India needs Modicare because nearly 70 per cent of what an Indian spends on healthcare, comes out of their own pocket.
Pro-market governments are typically identified with the interests of the rich capitalists and business owners. A perception has been created worldwide that right-leaning governments only pander to the top 10 per cent of the population while it is the left which concerns itself with “soft” sectors such as health, education and farmer development. In this context, the launch of the world’s biggest health insurance programme by the Narendra Modi government goes against the vein of this compartmentalisation.

It is for the first time in the economic history of independent India that health has emerged as the biggest headline of the budget announcement. For, I do not remember when was the last time that finance gurus on the day of the budget announcement were talking about a subject so seemingly “left”.

Finance Minister Arun Jaitley today (1 February) announced the launch of a new flagship National Health Protection Scheme, which aims to cover nearly 50 crore beneficiaries. This entails a whopping Rs 5 lakh per family per year to cover secondary and tertiary hospitalisation charges.

Let us analyse how this will apply to the Indian context.

Despite an over-reliance on the socialist model of healthcare spending, India offers one of the poorest levels of financial risk protection to its health-seeking citizens. Nearly 67 per cent of what an average Indian spends on healthcare comes out of their own pocket, and less than 30 per cent of their expenses are covered by either government services or insurance cover. If we translate these medical expenses nationwide, every year, nearly six crore Indian households fall below the poverty line only because they are not able to pay for their medical expenses. And a majority of the affected populations are the Dalits, tribals, and those from rural and poor households.

The missing link in this picture is the absence of a comprehensive health insurance model in India. Nearly 86 per cent of rural Indians and 82 per cent of the urban populace are still not covered under any scheme of health expenditure support or insurance system. Though attempts like the Rashtriya Swasthya Bima Yojana were made previously, a systematic effort to provide social security and health insurance cover were missing. It is in this light that the government’s commitment to launch the world’s largest health insurance scheme sets India on the path of progressive universal health insurance.

This is proposed to be complimented by the setting up of over 1.5 lakh health and wellness centres, which will “bring healthcare closer to home”. Keeping in line with the data that nearly 70 per cent of the out-of-pocket expenses in the Indian healthcare industry are on drugs and diagnostics, these centres will primarily focus on the same. Additionally, 24 new government medical colleges and hospitals will be set up by upgrading district hospitals in the country, to ensure that there is one medical college for three parliamentary constituencies.

The right to lead a healthy life is increasingly being recognised the world over as one of the central pillars of human rights and social justice. India’s commitment towards universal health insurance, therefore, seems like the right recipe to balance the market-led growth of the economy with health insurance and financial risk protection.

Dr Ananya Awasthi is Assistant Director, Harvard India Research Centre, Mumbai.

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So we are talking of 500 million people, each covered for ~ $8,000 for secondary and tertiary care. That is a whopping $4,000 billion = $4 trillion in coverage

I am not sure how much is the budgetary outlay for it? Assuming 0.5% needing such care, the expenditure is $20billion

I do not think that this is a wise way to go about it.

Better would have been to use the $20 billion/year to build N units with certain specialties evenly spread across population. Next year another N with another $20billion in newer areas, thus every year the reach of population to these care centers increases along with the density of such care centers adding N every year.

This would generate employment in rural areas of every kind, from providing low cost accommodations, low cost food to visitors and relatives, daily supplies from local villages to these centers - positively impacting rural economy. Pilferage, theft, misuse and corruption in such places should be dealt with VERY VERY Severe punishments. And Governance of such care centers should be made complete public - who is on duty at what time, which patient is for what treatment and how many days, etc. 24x7 Web cams should be provided for anyone to inspect and keep watch over its operations.

We spend billions and martyr hundreds of security personnel every year to secure our external borders. It is not just for a piece of land but for the people and the land that belong to them and for them to prosper. India's internal governance need to be managed with same vigor against its enemies lying within its borders. Most of it is the CORRUPT Congress and the COMMIES.
 
I am not sure how much is the budgetary outlay for it? Assuming 0.5% needing such care, the expenditure is $20billion
The hard thing is that now it has been announced and introduced, it will be hard to withdraw from or even lessen the scope. I wonder if BJP is playing a scorched earth game with opposition. No one can remain popular after saying no to this. They will be branded poor hating.

It seems we are trying to be more generous before getting to middle class.
 
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This all good but how will India fund this massive massive health plan?

Please note that I am not against it. I am just wondering how does Indian government plans to fund the massive bill for health plan for half a billion people?

May be by breaking all the Pharma patents?
May be HUGE tax increase is coming our way?
May be massive cut in spending in some other area, say defence?
May be huge debt? More sovereign bonds on the way?

How will they find it is a trillion dollar question. Because even mere 100 dollars per person (Rs 6500) will yield 50 billion dollar bill. Thats more than 10% of government revenue.


 
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So we are talking of 500 million people, each covered for ~ $8,000 for secondary and tertiary care. That is a whopping $4,000 billion = $4 trillion in coverage

I am not sure how much is the budgetary outlay for it? Assuming 0.5% needing such care, the expenditure is $20billion

I do not think that this is a wise way to go about it.

Better would have been to use the $20 billion/year to build N units with certain specialties evenly spread across population. Next year another N with another $20billion in newer areas, thus every year the reach of population to these care centers increases along with the density of such care centers adding N every year.

This would generate employment in rural areas of every kind, from providing low cost accommodations, low cost food to visitors and relatives, daily supplies from local villages to these centers - positively impacting rural economy. Pilferage, theft, misuse and corruption in such places should be dealt with VERY VERY Severe punishments. And Governance of such care centers should be made complete public - who is on duty at what time, which patient is for what treatment and how many days, etc. 24x7 Web cams should be provided for anyone to inspect and keep watch over its operations.

We spend billions and martyr hundreds of security personnel every year to secure our external borders. It is not just for a piece of land but for the people and the land that belong to them and for them to prosper. India's internal governance need to be managed with same vigor against its enemies lying within its borders. Most of it is the CORRUPT Congress and the COMMIES.
It's 5 lakhs per family so that makes it $800 billion worth coverage. Regarding premium, current estimation by government is around $2 billion.
 
Plus currently lots of different state schemes are there. These schemes are small and fragmented. All these can be combined under one scheme to be more effective.
 
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A lot of confusion here. Let me clarify from what I learned from NIti ayaog press conference.
  • All over the world primary health care is a public duty not private.
  • This will be a two-part program (Ayushman Bharat) 1) Infrastructure building 2) Insurance Scheme.
  • Center and state will share cost 60:40
  • It will take 5-6 months to roll out.
  • There will be a new autonomous authority to regulate social security on center and state level.
Insurance:
  • On the state level, there are already 24 insurance programs. (most will be subsumed)
  • The program will be for bottom10 cr families which will be extended to whole india in phases.
  • Each family can have cover up to 5 lakh. Will be 100% free.
  • Will be fully government-supported, with no cap on family size. It will be a nationally-portable scheme, utilised across the country.
  • It will cost around Rs1,000-1200 per family. So for 10 cr family, Rs 10,000-12000 cr needed.
  • About budget: 2000 cr already allocated (FM said it will be increased as the program requirement). Aditional 1% health cess is suppose to bring Rs 10,000 cr.
  • It will be based on Socio Economic and Caste Census.
  • It will automatic signup and Aadhar is not mandatory.
  • Ayushman Bharat provides flexibility to states to either adopt insurance company model as in Rajasthan or trust model as practiced in Karnataka.
  • Kerala already has a scheme which actually helped public health system improve since 65% money came to it.
Infra and HR:
  • 1.5 lakh wellness centers will be established.
  • Wellness Centres will be the foundation for India's Healthcare. It will be the first point of medical support within the common people reach.
  • India has a serious shortage of doctors. These centers would be manned by specially trained nurses for the large part.
  • It would be paperless and cashless.
@Nilgiri @Aashish @Arvind @nair
 
In short, nothing for me who pay taxes.
Every Indian pays taxes, you just don't see it. :giggle: No Indian is a freeloader. Every Indian is a asset to the nation. Learn to see things positively.
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@Aravind
Self preservation and continuation of lineage is the prime goals of every species.
'Sa Vis Pacem,Parabellum" (If you want peace, prepare for War)
It is hard to fight an enemy who has outposts in your head.
Homo Sapien is a species.
 
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Not exactly, 500 million people are covered. It means half of population, it will be full coverage of rest of population like NHS in future beyond 2019 .
I admire your optimism- in reality a massive injection of $ would be required to implement this - where’s the money going to come from?
 
ex-finance minister P Chidambaram:
"The promise of Rs. 5 lakh per family for secondary and tertiary healthcare is a big 'jumla'. The target group is 10 crore families. Assuming each family will avail of Rs. 50,000 - one tenth of Rs. 5 lakh - the amount required per year will be Rs. 5 lakh crore," he said.

and that guy is harvard graduate!
he definitely knows that if 10 million people take insurance, then all of them WONT avail the insurance. thats how insurance work - by spreading the risk across the population.

by saying that every family might avail 10% of the insurance thats saying every family of the 10 crore will be sick- imagine 10 crore families being sick every year - thats NOT how insurance works Mr. Finance Minister, and I am pretty sure you know that, you are willfully spreading misinformation to confuse the people.
 
I admire your optimism- in reality a massive injection of $ would be required to implement this - where’s the money going to come from?

let me put this in context:
State governments such as Tamil Nadu, Rajasthan and Kerala have successfully implemented insurance schemes with premiums of as low as Rs 350 per year and a health insurance cover of Rs 2 lakh per family of five.

Read more at:
//economictimes.indiatimes.com/articleshow/62744914.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
 
let me put this in context:
State governments such as Tamil Nadu, Rajasthan and Kerala have successfully implemented insurance schemes with premiums of as low as Rs 350 per year and a health insurance cover of Rs 2 lakh per family of five.

Read more at:
//economictimes.indiatimes.com/articleshow/62744914.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
Premiums and insurance rates are based on the claims made. Attempting to fix low rates may be exposing the risk and putting the financial services at risk.
Without sounding sceptical friend - I think it’s a tall order with your time constraints.
One thing that may help the figures would be the cheapness of drugs in the indian market.