Page 18 - Insurance Times August 2019

fictitious enrolments, unnecessary hospitalizations or supply side response. The fact that the scheme will be
unnecessary hysterectomies, and other such instances. An available across the country will bring private sector
integrated approach to implementing all the three initiatives healthcare providers to Tier-3 and Tier- 4 towns and expand
would have far-reaching effects on the country's healthcare operations there. Today, 1.3 billion plus Indians are served
scenario, and we could see a healthier India. by 10,00,000 registered doctors instead of 15,00,000, if one
were to comply to WHO's recommendation for optimum
Rationalizing treatment or surgical procedures, and use of access to health and quality care for all.
medicines and diagnostics will bring in reduction in
healthcare costs. This would also lead to stabilizing the Shortage of 5,00,000 doctors is a herculean supply gap to
premiums of NHPS and ensuring continuous improvements catch-up with, when the number of new doctors made in
in terms of coverage. The government is expecting a India per year is merely 65,000 (total MBBS and BDS
challenge in rolling out the National Health Protection enrolments in public and private medical colleges). 2500-
Mission (NHPM) to the urban poor after completing the first 3000 leaves for foreign shores every year for post-graduate
round of data cleansing earlier this month. Billed as the education or for work. The healthcare market will expand
world's largest health assurance scheme, NHPM aims to hugely and it will have the potential to bring prices down
provide free health insurance of Rs 5 lakh per family to because of its scale. Also, the protocols that will be signed
nearly 40% of the population-more than 100 million poor between health insurance companies and healthcare
and vulnerable families based on Socio Economic Caste providers will become benchmarks for other private
Census (SECC). providers. That will also help in bringing prices down. One
will also see a shift towards use of generics from costly
ABNHPM as Modicare: branded drugs. The whole healthcare paradigm will radically
transform.
In March 2018, the Cabinet cleared the Ayushman Bharat
National Health Protection Mission, dubbed Modicare. The
Union cabinet signed off on Ayushman Bharat National World's largest health Insurance Cover:

Health Protection Mission (AB-NHPM), the ambitious social The NHPM, labelled the world's largest health assurance
welfare programme announced in the Union budget for cover, aims to provide health insurance to nearly 40% of the
2018-19. It set the stage for the rollout of the scheme that population-i.e. more than 100 million poor and vulnerable
has come to be dubbed "Modicare" (like the medical plan families-with the premium paid by the government. The
for the poorest in the US came to be called Obamacare) and finance ministry had initially announced an outlay of Rs
is estimated to cost anywhere upwards of Rs12,000 crore 2,000 crore. The Union health ministry announced an
annually. allocation of Rs10,000 crore to Modicare for next two years.
With NHPM, it is very likely that investment in mid-size
At the minimum, this scheme aims to provide healthcare hospitals with more than 50 beds and more will increase.
to 500 million poor and vulnerable people by funding their This may cut the costs of the health services considerably.
secondary and tertiary healthcare costs-for beneficiaries it
will be a cashless and paperless transaction. Undoubtedly NHPM will be an entitlement-based scheme based on data
this is the most ambitious social welfare programme being from the deprivation criteria in the Socio-Economic Caste
attempted by the Prime Minister. It is something that is long
overdue-to be sure, versions of it already exist at the state
level and even the Union government-and one that the
Union government can't afford to botch up in
implementation.

A successful rollout of Modicare will accelerate the healthy
healthcare system. It is clear that while indeed Modicare is
a social cause, the associated political stakes too are equally
compelling. NHPM, often called Modicare, is set to
significantly lower the cost of healthcare at private hospitals
by scaling up the healthcare market. NHPM will bring a huge

18 The Insurance Times, August 2019