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Rediff.com  » Business » Testing for Modicare to start by July

Testing for Modicare to start by July

March 23, 2018 16:57 IST

By April, operational guidelines for the scheme will be finalised and shared with states

Illustration: Uttam Ghosh/Rediff.com

With the Union Cabinet approving the Ayushman Bharat health insurance scheme, the plan is to get into testing by July to assess the systems in place.

Health Minister J P Nadda said it would be launched pan-India at one go.

 

The prime minister is expected, though there is no official word, to announce the launch in his August 15 speech.

By April, operational guidelines for the scheme will be finalised and shared with states.

Nadda said the Centre’s share will be Rs 10,000 crore for two years.

The allocation will include premium payment for the coverage and logistics such as updating the Socio Economic Caste Census, used to identify beneficiaries.

Nadda said there will be no paucity of funds for it.

“Once the scheme gets up and running, we can get funds even then,” he promised.

Health secretary Preeti Sudan said apart from organ transplant, all other treatments will be provided for those eligible.

This scheme will also be portable, said the minister, adding a card holder in Bihar can get surgery done even in Tamil Nadu.

Transfer of funds will be through an escrow account directly, so that funds are transferred in an efficient and timely fashion, went an official statement.

Transactions will be paperless and cashless. Private hospitals may also provide treatment under it, once empanelled with the government.

The biggest challenge is to integrate central and existing state schemes; SECC data is not linked with Aadhaar, the citizen identification.

States would be provided the flexibility to expand their existing schemes till the time the SECC data is seeded with Aadhaar.

NHPS will replace the existing Rashtriya Swasthya Bima Yojana, which provides annual health cover up to Rs 30,000.

NHPS’ coverage is up to Rs 500,000 for a family. The aim is to cover at least 40 per cent of the population, which would be  107.4 million households or about 500 mn people.

Meanwhile, the ministry has also been engaging with insurance players who play a crucial role in implementing this scheme.

One executive from a general insurance company, who wished to not be named, told Business Standard,"the premium rates at this juncture is too inadequate,therefore once it is decided what the controls and limits will be for the various treatments, we can set the premium at an appropriate level so that insurance companies don't bleed the way the did under RSBY."

The insurance executive, stated that it was the industry's understanding that the scheme would be supported by a strong technological framework, which is key to the successful implementation of the scheme.

Further, he stated that insurance companies are most concerned about the probability of a large number fraudulent claims under the policy.

"We want is a strong deterrence mechanism when it comes to fraud.

"Today, the Insurance regulatory and develop authority of India (IRDAI) can haul up insurers and third party service providers, if there is any wrong-doing on their part, but if a hospital does something in most cases nothing comes of it.

"The medical council is there but it has no teeth, and people have to follow the regular police and judicial process to seek justice or fix the fraud," he said.

It seems that under the NHPS, insurers want to ensure that all parties participating in the delivery of health-care services, from hospitals to insurance companies to third-parties, each entity is treated with equally when there is unethical or fraudulent activity discovered, and that there should be strong and clear provisions for penalising any wrong-doing under NHPS.

Veena Mani in New Delhi
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