Page 11 - Insurance Times June 2019

Health Insurance

Medical reimbursement 'Modicare', a step towards universal health coverage in
claimed by employees India, says US think tank
not bounty: Madras HC Ayushman Bharat marks a significant step towards universal health coverage
but the government should ensure that it is
Madras High Court has recently
ruled in Marimuthu v. Government sustainable and delivers the high-quality care
of Tamil Nadu that medical reim- that Indians need, a top American think-tank
bursement claimed by the employ- said.
ees and pensioners or their family
Based on the analysis of the first year of
members is not the bonus or
Pradhan Mantri - Jan Arogya Yojana (PM-JAY),
bounty. It noted that since it has
popularly known as "Modicare", researchers
been made compulsory that, every
at the Washington DC-based Centre for Global Development (CGD) said the over-
employee or pensioner of the state
government must join in the Health all effort has been positive but they also highlighted challenges and several po-
Insurance Scheme by paying a con- tential pitfalls related to cost and quality that could derail the scheme's progress.
tinuous contribution towards pre-
"Modicare has put healthcare within reach for hundreds of millions, significantly
mium every month, the government
increasing the number of people who have government-funded health insur-
cannot easily abdicate their duty
ance and far exceeding the initial estimates," said Amanda Glassman, chief op-
and responsibility by merely reject-
erating officer at CGD and one of the authors of the study.
ing the case of medical reimburse-
ment claim on technical grounds.
"We found that more than 500 million people are now eligible for coverage by
The issue raised in the writ petitions Modicare or state-funded expansions of the programme. That is an impressive
before the court was the entitlement number, but there is still lots of work to do to bring down costs and bring up
of the writ petitioners, who are ei-
quality," Glassman said ahead of the release of the report.
ther government employees or pen-
sioners of the state government and The government must take a more active approach in not just helping Indians
its undertakings or their family pay for healthcare, but making sure they are getting the highest quality care
members/legal heirs/next kith and possible, the researchers write in the report.
kin, to get medical reimbursement
Additionally, the researchers explain that embracing and improving access to
under the New Health Insurance
primary care and linking it with the hospitalisation plan, rather than only pro-
implemented by the state govern-
ment from time to time. viding hospitalisation, would go a long way toward promoting better health.
The bench of Justice R. Suresh Kumar The focus in the first year of Modicare has been on expanding access to health
found that the District Level Empow- insurance, but at some point, the government needs to take steps to tackle the
ered Committee has rejected the
costs of the programme, the researchers said.
claim of petitioners for reimburse-
ment in one line without giving any "India has done an impressive job expanding health but there's still a lot of work
plausible or acceptable reason like to do. The next big step is making sure that Modicare is sustainable and that it
the treatment taken in non-network delivers the high-quality care which Indians need," KalipsoChalkidou, a senior
hospital or for the non-listed disease. fellow at CGD and an author of the study, said.

The Insurance Times, June 2019 11