Prime Minister Narendra Modi has announced that Pradhan Mantri Jan Arogya Abhiyaan, a mega health insurance scheme that provides Rs 5 lakh cover to 50 crore economically weak citizens of India, will be launched on September 25, on the birth anniversary of Pandit Deendayal Upadhyay. Delivering his Independence day address from the ramparts of Red Fort, Modi said that it is high time India ensures that its poor get access to good quality and affordable healthcare.
What is the significance of the announcement?
Well, it has set a deadline for the roll out of Pradhan Mantri Jan Arogya Abhiyaan, a project that was first announced as part of an umbrella scheme Ayushman Bharat by Finance Minister Arun Jaitley during his budget speech earlier this year. In fact, the budget day announcement was an improvement over yet another national health protection plan that was announced during his budget speech in 2016. A deadline hence provides a certainty to the whole project.
What is the scope of the scheme?
A benefit cover of Rs 5 lakh per family per year as entitlement (without any premium from the beneficiary side) is itself huge. Further, the benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country. Every person in the Socio Economic Caste Census (SECC) database will automatically be enrolled in the scheme. While the beneficiaries can avail benefits in both public and empanelled private facilities, the payments for treatment will be done on package rate (to be defined by the government in advance) basis.
What are the challenges?
Cordial relationship between centre and states are necessary for the smooth implementation of the scheme. For the benefits to be seamless, every state should come on a common IT platform. The roll out will be in phases are the level of preparation varies from state to state.
Any successful pilot projects?
The entire IT platform that will be used for this project has been licensed out from Telengana, where a miniature version of this scheme has been going on for years now.
Where do we stand now?
A National Health Agency to coordinate and steer the roll out of the programme is already in place. The agency has signed MoUs with almost every state and union territory to streamline their existing health insurance schemes with that of the new umbrella scheme. Empanelment of hospitals are going on, package rates being finalised and implementation model -- either through insurance companies or through state level trusts -- are being firmed up. At least six states have the technical and administrative capability to launch the project today.