Modicare: India’s mega healthcare scheme set to be launched on 25th September

New Delhi: During his Independence Day speech, Prime Minister Narendra Modi on 15th August announced that Pradhan Mantri Jan Arogya Abhiyaan, also known as Ayushman Bharat or the National Health Protection Mission (AB-NHPM) or Modicare, will be launched on 25th September. The government-sponsored health insurance scheme will provide free coverage of upto Rs 5 lakh per family per year at any government or even empanelled private hospitals all over India.

“The Pradhan Mantri Jan ArogyaAbhiyan will be launched on 25th September, 2018 as a result from now on, common man need not suffer from problems of dreaded diseases,” mentioned the Prime Minister. He also added that, “New avenues are emerging for middle class families and youth in the field of health. New hospitals will be constructed in 2 tier and 3 tier cities. Medical staff will be established in huge numbers. Employment opportunities will be more in the years to come.”

Decoding Ayushman Bharat scheme

Once rolled out across the country, Ayushman Bharat will provide a cover of Rs 5 lakhs per family per year for secondary and tertiary medical care facilities. If you are eligible under the health insurance scheme, you get automatic coverage. Eligibility is based on Socio-Economic Caste Census (SECC) database. In case of hospitalization, you or your family members do not need to pay anything under the scheme provided you go to any government or empanelled private hospital.

Ayushman Bharat is unlike other medical insurance schemes where there is a waiting period for pre-existing diseases. All kinds of diseases are covered from day one of the Ayushman Bharat policy. The benefit cover includes both pre and post hospitalization expenses. Having an Aadhaar card is not mandatory to avail of Ayushman Bharat benefit but beneficiaries need to carry a prescribed ID to receive free treatment at the hospital.

Expert applaud the scheme, want its effective implementation

Commenting on the proposed scheme, Dr Sanjiv Kumar, Director, International Institute of Health Management and Research, New Delhi said, “The Jan Arogya-Ayushman Bharat scheme proposes to go boldly where no previous regime has gone. It enables a new consumer base access to a market which earlier it could ill afford. But the strain it adds on the public exchequer and how such massive numbers would be accounted for and disbursed to healthcare institutions across the country needs more clarity.”

The NHPS is a great idea in theory because of its vast coverage and equitable nature in the delivery of healthcare services. However, the experience of schemes such as the CGHS, RSBY, Aarogyashree and state GHS have shown that rates for reimbursement fixed by government agencies does not reflect actual costs borne by hospitals and clinical institutions. The viability of running successful organizations, the quality of both care delivered to patients and the pharmaceutical industry are matters that need to be looked into”, added Dr Kumar.

As per Dr Dharminder Nagar, MD, Paras Healthcare, “It is great to see the government is acting strongly and actively in making Ayushman Bharat a reality. The PM’s announcement of rolling in the policy under Pradhanmantri Jan Arogya through a technologically driven transparent platform is telling of the vision and purpose the government is working with. A part of the larger vision that Shri Narendra Modi outlined today is the planned inclusion of lower and upper middle calls at later stages of the initiative. The Government also seems to be wanting an effective launch, by initiating a ground level testing phase between now and September 25th when the policy will actually begin being implemented.”

Dr Nagar added further, “While the launch of the scheme is highly welcome, what is also needed to be addressed on a parallel track is accessibility to doctors and hospitals. Without improving our doctor-patient ratio, without increasing penetration of hospitals and tertiary care centres, without ensuring that all health centres in rural areas are equipped with specialists and diagnostic facilities, even this ambitious scheme will only partially serve the purpose. We hope Ayushman Bharat paves way for a concerted effort on improving India’s healthcare facilities.”