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Union Budget 2018: ‘Modicare’ to provide health insurance to 500 million Indians

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prasad1

Well-known member
The Narendra Modi government has announced a transformative public health programme offering health insurance cover of up to Rs5 lakh to 100 million poor and vulnerable families, with the benefits expected to reach 500 million individuals, 40% of India’s population.

“It is taking health care to a new aspirational level as it is going to be the world’s largest government-funded programme,” said Arun Jaitley, finance minister, in his budget speech about the National Health Protection Scheme (NHPS), which is being referred to as ‘Modicare’.


It’s the world’s biggest health protection scheme by size, not budget, and will raise health cover by up to 17 times from the existing Rashtriya Swasthya Bima Yojana (RSBY) that caps it at Rs30,000 per year. The outlay for RSBY went up from Rs1,000 crore in 2017 to Rs2,000 crore this year.
 
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krish44

Well-known member
It would be good if Modi govt gets the health programme implemented.It would benefit the rural poor

Congress has dismissed it as ' jumla' and pre election stunt
 

prasad1

Well-known member
Welcome Back Krishji.


The concern with the health protection scheme is whether the insurance companies would make it worthwhile for hospitals to extend services easily.

Unfolding the budget, the finance minister devoted at least six paragraphs to support specific health initiatives.

But, there are ‘buts’. Because there are no details of how the schemes would pan out, one is left wondering whether and to what extent there would be a gap between intention and action. Providing insurance coverage through a national health protection scheme for poor families, and providing up to Rs 5 lakh per family per year for hospitalisation sounds fantastic.

But the concern is whether the insurance companies would make it worthwhile for hospitals to extend services easily, efficiently, and with compassion. In case it is a cashless facility, the costing would be between the hospital managements and the insurance setup.


Judging from the implementation of the much smaller Central Government Health Scheme, the payouts by the government have been chronically slow and cumbersome, and many hospitals have opted out. It is precisely because of the track record of delayed payments that one is concerned. The management of the programme would have to devolve on the states, which do not function at the same level of professionalism.

Given the laxity of many states and the dismal state of district hospitals, such a scheme may well take years to fructify. The question of assured funding has to be addressed and provided for. The size of the health budget does not give evidence of that. A clear understanding of the responsibilities of the Centre and the states is also needed. Without clear ownership for outcomes, the scheme may flounder.

https://theprint.in/2018/02/02/modicare-not-jumla-much-thinking-needed-accountability-funding/
 
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This one is from New York times, a positive news
[h=1]India Wants to Give Half a Billion People Free Health Care[/h]


Patients waiting to register at a government hospital in Bhopal, India, on Thursday. Government-run hospitals are theoretically free for everyone, but quality is poor and corruption is endemic
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NEW DELHI — India announced on Thursday a sweeping plan to give half a billion poor Indians free access to health care, as Prime Minister Narendra Modi seeks to address rising demands for greater economic and social protections before national elections next year.
The move is sure to be popular in a country where most people have no health insurance and the per capita income is a few dollars a day. Although India’s overall economy is growing, Mr. Modi and his governing Bharatiya Janata Party have been trying to find ways to court the population left behind.

“In poor people’s lives, one big worry is how to treat illness,” Mr. Modi tweeted in Hindi after the plan was announced. The new program, he said, “will free poor people from this big worry.”

The health care plan, part of the government’s 2018-19 budget presented on Thursday, would offer 100 million families up to 500,000 rupees, or about $7,860, of coverage each year. That sum, while small by Western standards, would be enough to cover the equivalent of five heart surgeries in India. Officials did not outline eligibility requirements, and many details of the program have yet to be finalized.

Read more at: https://www.nytimes.com/2018/02/01/business/india-modi-health-care.html
 

dhikshita

Banned
An excellent and comprehensive write up enlightening the the positive negative sides of a world largest health insurance coverage covering the downtrodden tobe implemented. Of course as mentioned lot of Ifs and buts besides there would be a gap between the real intention and the positive action. A bird's eye view denotes the benefeshers would be the insurance companies and the servicing hospital,selaiyur but not the poor as enshrined in the draft.
 

dhikshita

Banned
While actually approaching to get the benefit of this noble or novel scheme to be introduced, one poorman would have to undergo a lot of hiccups and mental agony, besides drawbacks from the implementing officials and finally the frustration alone remain in his mind.
 

prasad1

Well-known member
Welcome dhikshitaji,

The plan is a grand vision. One has to have the vision to achieve a goal.
But the devil is in the detail. I understand your point. I too have my doubts.

We have to see how it is implemented.
 

prasad1

Well-known member
A similar scheme is in vogue in Tamil Nadu. The poor people are really benefited.

Thank you, For bringing this. Instead of being a stone rattling in an empty tin can, this is music.

Can you expand on your post? I would like to know how it works? Do you have any personal knowledge of how it is being used?

Can I go to Apollo Hospital under this scheme?


I did search and found the following.

Eligibility:

Every member of a family whose annual family income is less than Rs.72,000/- as certified by Village Administrative Officer and such other person who may be declared to be eligible for coverage under the "Chief Minister's Comprehensive Health Insurance Scheme" by the Government will be "Eligible Persons" under the Scheme."Family" includes the eligible member, and the members of his or her family as detailed below:
i. Legal spouse of the eligible person;
ii. Children of the eligible person till they get employed or married or attain the age of 25 years, whichever is earlier, and who are dependent on the eligible person;
iii. Dependent parents of the eligible person.
Provided that if any person, in any of the categories at (i), (ii) or (iii) above, finds place in the family ration card, then it shall be presumed that the person is member of the family, and no further confirmation would be required.
If any member of the family of an eligible person is eligible to have his/her name included in the family of an another eligible person, he/she would be eligible to have his/her name included in one health insurance identity card only and claim assistance under one card only.
Once the Children of the family head
  1. gets employed or
  2. married or
  3. attains the age of 25 years, whichever is earlier should obtain fresh smart cards after establishing the eligibility with the proof of the coverage in the Family Ration Card and the Smart Card as well as the Income Certificate from the VAO.
The new enrolment and issue of cards will be through district kiosk established by the insurance company at the District Collectorate.

THE SCHEME

This is a lofty Insurance Scheme launched by the Tamil Nadu State Government through the United India Insurance Company Ltd (a Public Sector Insurer headquartered at Chennai) to provide free medical and surgical treatment in Government and Private hospitals to the members of any family whose annual family income is less than Rs.72,000/- (as certified by the Village Administrative Officers) .The Scheme provides coverage for meeting all expenses relating to hospitalization of beneficiary as defined in the Scope of the Scheme.BENEFITS

The scheme seeks to provide cashless hospitalisation facility for certain specified ailments/ procedures. The scheme provides a coverage up to Rs.1,00,000/- per family per year on a floater basis for the ailments and procedures covered under the Annexure "C".
For certain specified ailments and procedures of critical nature, which are listed under Annexure "D" in the Scheme, the overall limit is increased from Rs.1,00,000/- to Rs.1,50,000/-
There are 2 other covers other than the hospitalisation benefits under Annexure "C" & "D" available under the Scheme. They are a) Follow-up Treatment as listed under Annexure "E"& b) Additional Diagnostic procedures listed under Annexure "F"AVAILING THE BENEFITS

Free health camps / screening camps will be conducted by network hospitals as per the directions given by Project Director of Tamil Nadu Health Systems Society. Minimum of one camp per month per empanelled hospital will be held in the districts in each policy year. The persons who need treatment are identified in the Health camps. Such patients can approach the hospital in the network and follow the guidelines below:
  1. A new Health Insurance identity card with biometrics is being issued to all those members who have been holding the smart cards in the earlier scheme. Till such time new cards are issued the public can use the earlier smart (Health) cards
  2. This card should be shown at the Assistance Counter established at the empanelled hospital.
  3. After due verification of the details and authenticating the identity of the patient by the Liaison Officer, the necessary Pre-authorisation request for cashless facility will be submitted by the DMO of the hospital.
  4. The Project Office will approve the request on authentication of the identity and provided the procedure planned is within the Scheme
Even those patients who have the smart cards, though not identified through the Health Camps can also avail the benefit as above http://www.cmchistn.com/eligibility_en.html
 
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While actually approaching to get the benefit of this noble or novel scheme to be introduced, one poorman would have to undergo a lot of hiccups and mental agony, besides drawbacks from the implementing officials and finally the frustration alone remain in his mind.

[h=1]Apollo Hospital Chairman Dr.Pratap Reddy welcomed Centres announcement of new Health Insurance coverage for 10 crore families as it will benefit the poor and the needy.

A big Thumps Up To 'Modicare' [/h]


[FONT=&quot]Prime Minister Narendra Modi addresses the nation after the presentation of Union Budget 2018-19 in New Delhi on Feb1, 2018. (Photo: Video Grab/IANS)
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The Budget 2018 has received rave reviews from the healthcare industry experts. They believe that it will not only give a boost to the healthcare industry , but also help provide quality healthcare to millions of poor Indians. The National Healthcare Protection Scheme (NHPS), many believe, is the world’s largest health insurance scheme—which the finance minister has called ‘Modicare.’ Here is who said what:

Dr Prathap Reddy, Chairman, Apollo Hospitals

My heartiest congratulations to the government for investing in creating a swasth bharat by launching the Ayushman Bharat programme. Such ambitious out- of- the- box thinking was a need of the hour and the government has not disappointed. The initiative to cover 10 crore families with 5 lakh per family/per year with insurance cover for secondary and tertiary healthcare will be a gamechanger.

Antony Jacob, CEO, Apollo Munich Health Insurance

The world's largest government's funded healthcare program - National Healthcare Protection Scheme (NHPS)-- announced by our the government, with approximately 500 million beneficiaries is a welcome move. It will not only help millions of poor Indians get quality healthcare, but will also create several lakh new jobs in the country as new healthcare facilities will come up in smaller districts and villages.

Mr. Pavan Choudary, Chairman & DG, MTaI

The custom duty on medical devices have been increased. It is surprising that on one hand, the government is giving healthcare relief to the common man, on the other it is reducing the extent of this relief by increasing custom duties in a category where 70% of the products are still imported.

Read more at: http://www.healthpost.in/news/a-big-...-modicare--699
 

prasad1

Well-known member
The Tamil Nadu iteration has an income limit of Less than Rs.72,000.

I remember that the Driver in my brother's home is Paid Rs 10,000 a month. So he does not qualify.
The Maid gets paid Rs. 8000.00. She does not qualify.

How does it work, unless there is corruption in the certification process?
 

prasad1

Well-known member
The Rs 12,000-crore estimate for the national scheme will be logical only if the government is able to get all the empaneled hospitals to agree to a fixed rate for procedures, said V Jagannathan, chairman and chief executive officer of Star Health and Allied Insurance Company Ltd., which has worked with Tamil Nadu and Andhra Pradesh to offer state-run health cover for below poverty line families. “The premium outgo, however, would still increase by another Rs 5,000-6,000 crore because of medical inflation.”

In the Union Budget 2018, Jaitley made no allocation for the new scheme, saying resources will be provided when needed. He increased the outlay to Rs 2,000 crore for the Rashtriya Swasthya Bima Yojana, an existing cashless scheme that provides a cover of Rs 30,000 for common diseases and surgeries to unorganised sector workers living below the poverty line and up to five of their family members. The new plan will have no such cap.

“The experience of past government-run health insurance schemes which were smaller in benefits and scale shows that adequate pricing is important for the long term,” said Joydeep Roy, partner and leader, insurance at PwC. “Pricing will depend on many factors and the process of enrollment and claim settlement. These need to be worked out and hospitalisation cost escalation controlled. Otherwise, an indicative price of Rs 1,100-1,200 per family may become inadequate after proper actuarial analysis.” Expenditure Secretary Ajay Narayan Jha said in a press conference on Friday that the Rashtriya Swasthya Bima Yojana will be converted into National Health Protection Scheme. It will be rolled out in six to eight months, Finance Secretary Hasmukh Adhia told BloombergQuint.

The central government will provide Rs 6,000 crore in the first year for the fully sponsored scheme with no premium and co-payment by beneficiaries. It will be offered either through an insurance or trust model.

The amount would still be too large for the government to cover it alone. Implementation has to be through public-private partnerships with insurance companies, said Roy. The biggest challenge would be uniform healthcare delivery and pricing. “Hospital costs vary widely across the country and there is no central healthcare regulator.”


Read more at: http://www.sify.com/finance/is-rs-12000-crore-enough-for-the-world-s-biggest-public-health-insurance-plan-news-finance-sceps6acchhje.html
 
Hope the two links are self-explanatory…

The first one is about the Schemes and its salient features and the second one is a study report submitted by a team consisting Prof. V. Pughazhendi, Dr. Jalal and Dr. Sunitha.

[h=1]Chief Minister's comprehensive health insurance scheme launched[/h]
Read more at: http://www.thehindu.com/news/national/tamil-nadu/chief-ministers-comprehensive-health-insurance-scheme-launched/article2793090.ece


ANALYSIS OF SATISFACTION OF BENEFICIARIES FROM THE. HEALTH INSURANCE SCHEME SSPONSORED BY GOVERNMENT OF. TAMIL NADU. Prof.V.Pugazhenthi1 ... Government Sponsored Health Insurance Scheme, 'Chief Minister's Comprehensive Health Insurance

Read more at: http://epratrust.com/articles/upload/2.Prof.V.Pugazhenthi.pdf?

[h=1][/h]
 
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