RSS affiliate Bharatiya Mazdoor Sangh (BMS), the country's largest trade union, has criticised the government for ignoring the need to implement a comprehensive health policy and instead focusing on a health insurance scheme that is a 'glorified' version of existing Rashtriya Swasthya Bima Yojana (RSBY).
"Tax payers' money is diverted to private insurance companies by way of premium. Health insurance is a big area for all foreign multinational players. Such schemes are pushed by the private sector," Saji Narayanan C K, President BMS, said.
The scheme Ayushman Bharat National Health Protection Mission (AB-NHPM), meant to provide health insurance cover of Rs 5 lakh per family per year to more than 10 crore poor and vulnerable families, was announced in Union Budget 2018-19. On March 21, Union Cabinet approved the launch of AB-NHPM that will subsume the on-going centrally sponsored schemes - RSBY and the Senior Citizen Health Insurance Scheme (SCHIS).
The beneficiaries will be allowed to avail benefits in both public and empanelled private facilities. "All public hospitals in the States implementing AB-NHPM, will be deemed empanelled for the scheme. Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter. As for private hospitals, they will be empanelled online based on defined criteria," a government release stated.
Since the state and central governments will share the premium burden on a pre-determined (60:40) ratio, the success of the schemes depends on the cooperation of the state governments. At least all BJP-ruled states are expected to fall in line in the initial phase. The scheme allows states to integrate AB-NHPM with its existing health insurance/protection schemes and expand AB-NHPM both horizontally and vertically.
"States will be free to choose the modalities for implementation. They can implement through insurance company or directly through Trust/ Society or a mixed model," the government clarifies.
The government has also decided to set up two agencies, Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister and Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) to manage the AB-NHPM at the operational level.
The government claims that AB-NHPM will have major impact on reduction of out of pocket (OOP) expenditure because of increased benefit cover to nearly 40 per cent of the population, (the poorest and the vulnerable), covering almost all secondary and many tertiary hospitalizations, (except a negative list) and a coverage of 5 lakh for each family, irrespective of its size.
However, BMS says the government's focus should have been on implementing a comprehensive health policy and benefits every citizen. "The government has announced a national health policy, but where is the matching budgetary allocation? There has to be continuity in policy decisions. Instead, the budget only talks about a glorified RSBY," Narayanan points out.
BMS says the government would have done a better job in ensuring social and health security to the poor by finalising and implementing a Social Security Code in the making.
"The government has prepared the draft. It is being circulated for stakeholder consultations. We believe that if the Code is enacted, every poor person will be entitled for not just health benefit, but about 14 other benefits that comprehensively ensures social security", Narayanan adds. According to him, welfare of rural India can happen only if all three pillars of growth are targeted simultaneously, education, health and minimum basic income.