Prime Minister Narendra Modi had launched his government's ambitious healthcare programme with much fanfare during the final days of last month. The programme has been named Ayushman Bharat - National Health Protection Scheme (AB-NHPS). The union government is planning to merge all the centrally sponsored health insurance schemes with AB-NHPS from 01 Apr '19.
Insuring the masses is a step in the right direction and let me run through the salient features of this programme:-
* Launched on 23 Sep '18, the AB-NHPS aims to provide healthcare coverage to over 10 crore
families.
* It offers an insurance cap of Rs.5 lakhs and is considered the biggest government sponsored
healthcare scheme in the world.
* Ten days into its launch, it has catered to more than 30,000 patients with claims of Rs.38.1 crores
approved by the government in both public and private hospitals.
* As of date, 32,814 hospitals have applied for empanellment of which 13,865 have been empanelled
or are in the process of being empanelled.
* While 31 states and union territories are on board, five states viz. Delhi, Orissa, Punjab, Kerala and
Telangana are resisting participation.
* Kerala has adopted a wait and watch policy and will join the scheme only after it gets more clarity.
The state has appointed a five-member committee to negotiate with the central government on
areas of concern.
* Kerala's main worry is the possible reduction in the number of beneficiaries from 41 lakhs in
Rashtriya Swasthya Bima Yojana(RSBY) to 21.5 lakhs if it opts for AB-NHPS.
* Also, Kerala claims that while it provides packages for the treatment of 1,785 ailments, the
AB-NHPS has only 1,354 packages.
* Also, with the limit being Rs.5 lakhs instead of Rs.30,000/- in RSBY, the state government fears
it will result in a tremendous financial burden.
Eligibilty Criteria.
(a) No enrollment but it is an entitlement-based scheme.
(b) Families are identified by the government based on deprivation and occupational criteria as per
the 2011 census data.
(c) A list of eligible families will be shared with the state governments. A dedicated AB-NHPS
family identification number will be allotted to eligible families.
(d) Additionally, families with active RSBY cards as on 28 Feb '18 will be covered. No new families
can be added under AB-NHPS.
Eligible Hospitals.
* Services under the scheme can be availed at all public hospitals and empanelled private health
care facilities. Also, the basic empanellment criteria allow empanellment of a hospital with a
minimum of 10 beds with the flexibility provided to states to further relax this, if required.
* To control costs, the payments for treatment will be done on package rates. However, hospitals
with NABH/NQAS accreditation can be incentivised for higher package rates subject to procedure
and costing guidelines.
And What is the Hospitalisation Process?
(a) No need to pay any charges and premium for the hospitalisation.
(b) Empanelled hospitals will have 'Ayushman Mitras' to assist patients.
AB-NHPS Benefits.
* A benefit cover of Rs.5 lakhs per family (On a family floater pass) per year for secondary and
tertiary care hospitalisation.
* No cap on family size and age.
* cashless and paperless scheme at public hospitals and empanelled private hospitals.
* Benefits of the scheme are portable across the country.
* Beneficiaries can avail cashless benefits from any public/private empanelled hospitals across the
country.
* It includes pre and post-hospitalisation expenses.
What is included?
It will cover medical and hospitalisation expenses for almost all secondary care and most of the tertiary care procedures. The health ministry has included 1,354 packages in the scheme under which treatment for coronary bypass, knee replacements and stenting among others would be provided at 15-20% cheaper rates than the Central Government Health Schemes(CGHS).
My take.
A great initiative and hope it's nurtured well, the needy will benefit and hopefully, the politicisation will soon be a thing of the past and the entire nation will come under this one healthcare programme!
Tailpiece.
Am quite surprised that more and more people - predominantly women - are coming out onto the streets voicing their dissent on the recent Supreme Court order regarding the clearing of entry of women in the Sabarimala shrine. From my interactions with many ladies, most of them if not all, find it difficult to accept that they should be entering a temple when they're menstruating. Yes, they consider themselves 'impure' during that period. Period!
Insuring the masses is a step in the right direction and let me run through the salient features of this programme:-
* Launched on 23 Sep '18, the AB-NHPS aims to provide healthcare coverage to over 10 crore
families.
* It offers an insurance cap of Rs.5 lakhs and is considered the biggest government sponsored
healthcare scheme in the world.
* Ten days into its launch, it has catered to more than 30,000 patients with claims of Rs.38.1 crores
approved by the government in both public and private hospitals.
* As of date, 32,814 hospitals have applied for empanellment of which 13,865 have been empanelled
or are in the process of being empanelled.
* While 31 states and union territories are on board, five states viz. Delhi, Orissa, Punjab, Kerala and
Telangana are resisting participation.
* Kerala has adopted a wait and watch policy and will join the scheme only after it gets more clarity.
The state has appointed a five-member committee to negotiate with the central government on
areas of concern.
* Kerala's main worry is the possible reduction in the number of beneficiaries from 41 lakhs in
Rashtriya Swasthya Bima Yojana(RSBY) to 21.5 lakhs if it opts for AB-NHPS.
* Also, Kerala claims that while it provides packages for the treatment of 1,785 ailments, the
AB-NHPS has only 1,354 packages.
* Also, with the limit being Rs.5 lakhs instead of Rs.30,000/- in RSBY, the state government fears
it will result in a tremendous financial burden.
Eligibilty Criteria.
(a) No enrollment but it is an entitlement-based scheme.
(b) Families are identified by the government based on deprivation and occupational criteria as per
the 2011 census data.
(c) A list of eligible families will be shared with the state governments. A dedicated AB-NHPS
family identification number will be allotted to eligible families.
(d) Additionally, families with active RSBY cards as on 28 Feb '18 will be covered. No new families
can be added under AB-NHPS.
Eligible Hospitals.
* Services under the scheme can be availed at all public hospitals and empanelled private health
care facilities. Also, the basic empanellment criteria allow empanellment of a hospital with a
minimum of 10 beds with the flexibility provided to states to further relax this, if required.
* To control costs, the payments for treatment will be done on package rates. However, hospitals
with NABH/NQAS accreditation can be incentivised for higher package rates subject to procedure
and costing guidelines.
And What is the Hospitalisation Process?
(a) No need to pay any charges and premium for the hospitalisation.
(b) Empanelled hospitals will have 'Ayushman Mitras' to assist patients.
AB-NHPS Benefits.
* A benefit cover of Rs.5 lakhs per family (On a family floater pass) per year for secondary and
tertiary care hospitalisation.
* No cap on family size and age.
* cashless and paperless scheme at public hospitals and empanelled private hospitals.
* Benefits of the scheme are portable across the country.
* Beneficiaries can avail cashless benefits from any public/private empanelled hospitals across the
country.
* It includes pre and post-hospitalisation expenses.
What is included?
It will cover medical and hospitalisation expenses for almost all secondary care and most of the tertiary care procedures. The health ministry has included 1,354 packages in the scheme under which treatment for coronary bypass, knee replacements and stenting among others would be provided at 15-20% cheaper rates than the Central Government Health Schemes(CGHS).
My take.
A great initiative and hope it's nurtured well, the needy will benefit and hopefully, the politicisation will soon be a thing of the past and the entire nation will come under this one healthcare programme!
Tailpiece.
Am quite surprised that more and more people - predominantly women - are coming out onto the streets voicing their dissent on the recent Supreme Court order regarding the clearing of entry of women in the Sabarimala shrine. From my interactions with many ladies, most of them if not all, find it difficult to accept that they should be entering a temple when they're menstruating. Yes, they consider themselves 'impure' during that period. Period!
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