February 4, 2018
World’s largest mega healthcare scheme National Health Protection Scheme (NHPS), which has been dubbed ‘Modicare’.
The Union Budget presented by Finance Minister Arun Jaitley on 1st February, saw the unveiling of a mega healthcare project that's being touted as the world’s largest such scheme, in both extent & expense.
The National Health Protection Scheme (NHPS), which has been dubbed ‘Modicare’ by Mr. Jaitley, has the objective of extending healthcare insurance to 100 million families & raises the insurance ceiling to ₹5 lakh per family.
The Ayushman Bharat scheme is also being called "ModiCare", is a new health protection scheme that would cover around 10 crore poor & vulnerable families or about 50 crore poor people of India.
"ModiCare" is seen as an attempt by the govt. to reform country's public health system, which faces acute shortage of doctors & hospitals,
- The scheme'll target up to 500 million individuals from financially vulnerable households, a demographic that accounts for 41.3 percent of the population, according to Census data.
- Under the NHPS, 4 in 10 Indians can avail of secondary & tertiary care in govt. & private hospitals, within the insurance cap earmarked per family.
- Secondary healthcare services include those provided by skilled medical practitioners, for outpatient treatment, or a brief stay at a hospital for serious illness.
- Tertiary care is for patients who're admitted to hospitals for longer bouts of illness & require the attention of specialist doctors. Tertiary care is extended to patients who're suffering from acute pain or terminal illness.
- A National Health agency will be instituted under this scheme to oversee its implementation at the state-level. The identification of beneficiaries is to be done by consulting the 2011 round of the socio-economic caste census.
- According to the media reports, calculations that factor in the current level of healthcare spending, reckon that the NHPS will require an expenditure outlay of over ₹1 lakh crore ($1,000 billion).
- Rashtriya Swasthya Bima Yojana (RSBY), which is the existing affordable-healthcare scheme, provides an insurance cover of ₹30,000 for a family comprising of at most 5 members. Out of the corpus earmarked for the scheme in the budget, the Central government pays 75% of the expense, while the rest is borne by the States. The RSBY, which is the precursor to Modicare, is targeted at Below Poverty Line (BPL) families & has been implemented in fifteen States.
- Modicare, which shares its blueprint with the 'Affordable Care Act' that was championed by Barack Obama in the United States, will provide a shot in the arm for the healthcare sector, increasing the insurance cover per family by over 1500% from ₹30,000 under the extant RSBY, to ₹5 lakh. The no. of beneficiaries will also increase, as more states enroll for the scheme. However, share of the States’ to the NHPS hasn't been detailed in the budget document.
- The NHPS, which is modelled along the lines of 'Obamacare', indicates the govt’s intent to further the beneficiary pool for healthcare sops. "India can't realize its demographic dividend without its citizens being healthy," said Mr. Jaitley in his budget speech.
- Ancillary to the NHPS, the govt. plans to set up 1.5 lakh Health and Wellness Centres centres under the Ayushman Bharat program. These centres will provide treatment for non-communicable diseases & disburse primary care to young mothers & children. Free supply of essential medication & diagnostics is also on the anvil.
- In order to meet the demand for accessibility to healthcare, more Government Medical Colleges & Hospitals are planned to be instituted towards the goal of having at least 1 medical college for every 3 parliamentary constituencies.
- At present, there are 479 medical colleges affiliated to the Medical Council of India (MCI) as opposed to 543 parliamentary constituencies. However, their spatial distribution is uneven, with more colleges being clustered around urban centres.
The no. of doctors per lakh population is also below par. A World Health Organization (WHO) report titled 'The Health Workforce in India' states that on an average, there're 79.7 doctors per 1 lakh people in the country.
Chandigarh has the most doctors per capita with 279.9 doctors per lakh of the population. Whereas, Meghalaya has only 27.5 lakh doctors per lakh of the population. All the north-eastern states lag behind the national average in the no. of healthcare professionals. Arunachal Pradesh & Nagaland have 32.5 & 35.6 doctors per lakh citizens respectively.
Another unflattering statistic which Modicare would seek to remedy is India’s low per capita expenditure at constant Purchasing Power Parity (PPP). Purchasing power parity is the net expenditure on a particular commodity after normalising the cost by accounting for the exchange rate. This metric is often used to compare income levels or the price of a basket of goods in different countries.
According to data compiled by the World Bank, India’s health expenditure per capita amounted to $267 in 2014, far below the world average of $1,271. The per capita spending on healthcare in India is less than other developing countries like Indonesia & African countries like Djibouti & Gabon, where the average citizen spends $338 & $599 respectively on healthcare.
Developed countries that invest in the health of their citizens, view the expenditure as a means to further the end of a more economically equitable society.
The Heritage Index of Economic Freedom 2018, which ranks the pecuniary freedom of citizens, found that the top 10 nations in the list all had universal healthcare schemes. Hong Kong, Singapore, Australia, New Zealand, Canada, Switzerland & Denmark are among the countries that make the top 10.
The United States, which is ranked 12, is upstaged on this front by Estonia & Chile, both of which have universal health coverage. India ranked 130 out of 180 countries in the study.
With inputs from Hindu.
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