RELEVANCE – UPSC GS PRELIMS & GS MAINS – II (Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes)
First go through the text (given after the questions) and then attempt the questions.
QUES 1 . Which among the following statements about Ayushman Bharat – National Health Protection Mission (AB-NHPM) is incorrect-
1 . It has subsumed the on-going centrally sponsored schemes -Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
2 . It was launched on April 14 , 2018.
3 . AB-NHPM will have a defined benefit cover of Rs. 10 lakh per family per year.
a . only 1
b . 1 & 2
c . only 2
d . only 3
Answer – d
QUES 2 . Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) set up under Ayushman Bharat – National Health Protection Mission (AB-NHPM) is headed by
a . Prime Minister
b . Union Health and Family Welfare Minister
c . Cabinet Secretary
d . Health Secretary
Answer – b
Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
AB-NHPM will subsume the on-going centrally sponsored schemes –Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).
The first Health and Wellness centre under Ayushman Bharat Scheme was inaugurated on April 14 , 2018 in Chhattisgarh’s Bijapur to mark the launch of Ayushman Bharat Yojana- National Health Protection Mission (AB-NHPM).
RSBY was launched in the year 2008 by the Ministry of Labour and Employment and provides cashless health insurance scheme with benefit coverage of Rs. 30.000/- per annum on a family floater basis [for 5 members], for Below Poverty Line (BPL) families, and 11 other defined categories of unorganised workers. To integrate RSBY into the health system and make it a part of the comprehensive health care vision of Government of India, RSBY was transferred to the Ministry of Health and Family Welfare (MoHFW) w.e.f 01.04.2015.
The NHPS comes in the backdrop of the fact that various Central Ministries and State/UT Governments have launched health insurance/ protection schemes for their own defined set of beneficiaries. There is a critical need to converge these schemes, so as to achieve improved efficiency, reach and coverage.
1 . AB-NHPM will have a defined benefit cover of Rs. 5 lakh per family per year.
2 . To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.
3 . The benefit cover will also include pre and post-hospitalisation expenses.
4 . A defined transport allowance per hospitalization will also be paid to the beneficiary.
5 . Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
6 . AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database.
Co-operative federalism and flexibility to states
One of the core principles of AB-NHPM is to co-operative federalism and flexibility to states. There is provision to partner the States through co-alliance. This will ensure appropriate integration with the existing health insurance/ protection schemes of various Central Ministries/Departments and State Governments (at their own cost) . State Governments will be allowed to expand AB-NHPM both horizontally and vertically. States will be free to choose the modalities for implementation. They can implement through insurance company or directly through Trust/ Society or a mixed model.
I . Ayushman Bharat National Health Protection Mission Council (AB-NHPMC)
For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
II . Ayushman Bharat National Health Protection Mission Governing Board (AB-NHPMGB)
It is proposed to have an Ayushman Bharat National Health Protection Mission Governing Board (AB-NHPMGB) which will be jointly chaired by Secretary (HFW) and Member (Health), NITI Aayog .
III . Ayushman Bharat – National Health Protection Mission Agency (AB-NHPMA)
It is proposed to establish an Ayushman Bharat – National Health Protection Mission Agency (AB-NHPMA) to manage the AB-NHPM at the operational level in the form of a Society.
IV . State Health Agency (SHA)
States would need to have State Health Agency (SHA) to implement the scheme . States will have the option to use an existing Trust / Society / Not for Profit Company/ State Nodal Agency or set up a new Trust / Society / Not for Profit Company/ State Health Agency to implement the scheme and act as SHA. At the district level also, a structure for implementation of the scheme will need to be set up.
In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction. This will also help in prevention / detection of any potential misuse / fraud / abuse cases. This will be backed by a well-defined Grievance Redressal Mechanism. In addition, pre-Authorisation of treatments with moral hazards (Potential of misuse) will be made mandatory.
In order to ensure that the scheme reaches the intended beneficiaries and other stakeholders, a comprehensive media and outreach strategy will be developed, which will, inter alia, include print media, electronic media, social media platforms, traditional media, IEC materials and outdoor activities.
In-patient hospitalization expenditure in India has increased nearly 300% during last ten years. (NSSO 2015). More than 80% of the expenditure are met by out of pocket (OOP).
Rural households primarily depended on their ‘household income / savings’ (68%) and on ‘borrowings’ (25%), the urban households relied much more on their ‘income / saving’ (75%) for financing expenditure on hospitalizations, and on ‘(18%) borrowings (NSSO 2015).
Out of pocket (OOP) expenditure in India is over 60% which leads to nearly 6 million families getting into poverty due to catastrophic health expenditures. AB-NHPM will have major impact on reduction of Out Of Pocket (OOP) expenditure on ground of:
i) Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable).
ii) Covering almost all secondary and many tertiary hospitalizations (except a negative list).
iii) Coverage of 5 lakh for each family (no restriction of family size).
This will lead to increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to.
This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus leading to improvement in quality of life.
Moreover AB-NHPM will create nearly one lakh jobs.
The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue.
Number of Beneficiaries
AB-NHPM will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban.
AB-NHPM will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries.