Union Cabinet approves Ayushman Bharat health scheme 

Union Cabinet approves Ayushman Bharat health scheme

Context

The Union Cabinet on Wednesday approved the launch of the Ayushman Bharat — National Health Protection Mission (AB-NHPM), which was announced in the Budget

Features of the scheme

• The scheme will provide a cover of ₹5 lakh per family per year
• It would take care of almost all secondary care and most of the tertiary care procedures
• There will be no cap on family size and age
• The benefits cover will include pre and post-hospitalization expenses
• All pre-existing conditions will be covered from day one of the policy
• A defined transport allowance per hospitalization will also be paid to the beneficiary
• AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database
• The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-NHPM, will be deemed empanelled for the Scheme
• 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
• Bodies to be set up:
  1. 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
  2. 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 with Financial Advisor, MoHFW, Additional Secretary & Mission Director, Ayushman Bharat National Health Protection Mission, MoHFW (AB-NHPM) and Joint Secretary (AB-NHPM), MoHFW as members
  3. 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. AB-NHPMA will be headed by a full time CEO of the level of Secretary/ Additional Secretary to the Government of India

• To ensure that the funds reach SHA on time, the transfer of funds from Central Government through AB-NHPMA to State Health Agencies may be done through an escrow account The State has to contribute its matching share of grants within defined time frame.
• Implementation by: At the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) would be put in place. States/ UTs would be advised to implement the scheme by a dedicated entity called State Health Agency (SHA)

Major impact

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