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Cabinet approves Ayushman Bharat – National Health Protection Mission Benefit cover of Rs. 5 lakh per family per year
More than 10 crore families to be covered
The Union Cabinet chaired by the Prime Minister Shri Narendra Modi on 21st MARCH has approved the launch of a new Centrally Sponsored Ayushman Bharat -National Health Protection Mission (AB-NHPM) having central sector component under Ayushman Bharat Mission anchored in the MoHFW.
The target beneficiaries of the proposed scheme will be more than 10 crore families belonging to poor and vulnerable population based on SECC database.
AB-NHPM will subsume the on-going centrally sponsored schemes -Rashtriya Swasthya BimaYojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS)
• 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 elfare (MoHFW) w.e.f 01.04.2015.
• During 2016-2017, 3.63 crore families were covered under RSBY in 278 districts of the country and they could avail medical treatment across the network of 8,697 empanelled hospitals.
Primary, secondary and tertiary care.
Primary care constitutes treatment on an out-patient basis.
Secondary care refers to hospita This cover will take care of almost all secondary care and most of tertiary care procedures.
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. The benefit cover will also include pre and post-hospitalisation 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.
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.
AB-NHPM will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database, The different categories in rural area include
families having only one room with kucha walls and kucharoof; families having no adult member between age 16 to 59; female headed households with no adult male member between age 16 to 59; disabled member and no able bodied adult member in the family;
SC/ST households; and landless households deriving major part of their income from manual casual labour, Also, automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families,
primitive tribal groups, legally released bonded labour.
For urban areas, 11 defined occupational categories are entitled under the scheme.
The beneficiaries can avail benefits in both public and empanelled private facilities
To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. The package rates will include all the costs associated with treatment. For beneficiaries, it will be a cashless, paper less transaction.
Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.
The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines AB-NHPM will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries.
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 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)
In a major boost to health infrastructure the Union Cabinet chaired by the Prime Minister Shri Narendra Modi has approved the continuation of the National Health Mission – with effect from
1st April 2017 To 31st March 2020
with a budgetary support of Rs. 85,217 crore as Central Share over this period.
Salient Features:
1. NHM will be the principle vehicle for the UHC (Universal Health Coverage)
2. The goals/targets aligned with National Health Policy, 2017 and SDG-3.
3. NHM has helped the country achieve the MDGs and will be the principal vehicle to achieve the SDG 3 targets including the target for UHC.
4. NHM will continue to strengthen the public health systems, particularly in high priority
Districts that include aspirational districts.
Transformation of 115 backward (aspirational) districts by April 2018.
These 115 backward districts include 35 districts affected by Left Wing Extremists (LWE) violence, 55 districts just affected by LWE and another 15 including districts in Jammu and Kashmir and northeast affected by terrorism (Odisha,Kerala,WB)
Salient Features:
Shift from selective to comprehensive primary health care that includes care for common non-communicable diseases, geriatric health care, palliative care and rehabilitative care services etc. through strengthening of the SHCs/PHCs as Health and Wellness Centres (HWCs).
SHC – 3000-5000
PHC – 20K-30K
CHC – 80K-120K
The HWCs would provide preventive, promotive, curative and rehabilitative services, including NCD screening and management and are expected to be linked to CHCs and the DHs through a two-way referral and follow up system to reduce fragmentation and improve continuity of care. Package of twelve services including free universal screening for common NCDs.
Emphasis on wellness by integration of AYUSH, and a focus on health promotion and prevention particularly for chronic diseases.
Special focus on reducing Out Of Pocket Expenditure (OOPE) with intensification of Initiatives such as NHM Free Drugs and Diagnostics Services Initiatives, Pradhan Mantri National Dialysis Programme – Reduction on OOPE incorporated as a separate target.
Sharpened focus on quality through Quality certification of public health facilities, Kayakalp, LaQshya. Utilisation of public health facilities is a specific target.
“Kayakalp”-an initiative for awards to public health facilities
“Kayakalp” initiative will encourage every public health facility in the country to work towards standards of excellence to help the facilities stay clean and hygienic. This does not apply only to physical cleanliness, but to develop and put in place systems and procedures for activities such as bio-waste disposal or protocols etc.
Based on the set criterion, prize winners will receive a cash award with a citation. First rank and second rank awardees at district level hospital will get Rs. 50 lakhs and Rs. 20 lakhs respectively.
While Rs. 15 lakhs and Rs. 10 lakhs are proposed for community health centres/sub district hospitals for the same criteria and winner at primary health centre will get Rs. 2 lakhs under this scheme.
Infant mortality rate has reduced from 66 in 2001 to 34 in 2016 It is estimated that approximately 46% maternal deaths, over 40% stillbirths and 40% neonatal deaths take place on the day of the delivery
Improvement in key health indicators like Neonatal Mortality Rate (NMR),
Infant Mortality
Rate (IMR),
Under-Five Mortality Rate (U5MR),
Maternal Mortality Rate (MMR) and Total
Fertility Rate (TFR)