MODICARE Ayushman Bharat scheme, otherwise known as Modicare under the National Health Mission was launched by Prime Minister Narendra Modi government on 23 September 2018. The scheme was as Pradhan Mantri Jan Arogya Yojana. The aim of the scheme was to create a healthy and fit India. The program focuses on creating a sound framework of wholistic healthcare where even the economically vulnerable population can have easy access to quality medical care. Components of Modicare Under the scheme, the government has rolled out two different sub-schemes which are1. Health and Wellness Centre The Union government has promised to establish around 1.5 lakh centers that will bridge the existing gap in our health care system. The centers will offer comprehensive health care (including non-communicable diseases and maternal and child health services). These centers will also provide essential drugs and diagnostic services for free of cost. 2. National Health Protection Scheme PMJAY scheme intends to cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries). It seeks to provide coverage up to Rs.5 lakh rupees per family per year for secondary and tertiary care hospitalization. Objectives of ModiCare (Ayushman Bharat Scheme) 1. To make secondary and tertiary healthcare completely cashless in nature. 2. To provide people with access to medical treatment without putting any pressure on their pockets. 3. To improve the status of health especially among the most vulnerable sections of society. 4. To promote the role of private players in the achievement of public health goals. 5. To improve the quality of life of citizens. 6. To expand the ambit of the national health framework and inculcate an integrated approach of health-care. 7. To reduce the out-of-pocket expenditure on healthcare. 8. To provide insurance cover to a minimum of 40% of the country’s total population 9. To take the nation closer to the achievement of the Sustainable Development Goal of Universal Health Coverage (SDG3: Good health and well-being). 10. To create a network of health centers where the focus is on early detection of diseases and providing treatment service for the same. Target Population of Modicare In the rural areas, the names of beneficiaries have been prepared considering various socioeconomic deprivations such as lack of housing facilities, meager income, and other deprivations. Going by this methodology, we arrive at the final list that translates into the following beneficiaries1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Those living in scheduled caste and scheduled tribe households Families with no male member aged between 16 to 59 years Beggars and destitute Families with no individuals aged between 16 and 59 years Families having at least one physically challenged member and no able-bodied adult Landless households who are making a living as casual manual laborers Primitive tribal communities Legally released bonded laborers Families living in one-room makeshift houses Families of Manual scavengers The urban area list of beneficiaries of Ayushman Bharat has been drawn up on the basis of occupation. Those people from the urban population who can avail the benefits under this scheme are1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Washerman/chowkidars Home-based artisans or handicraft workers, tailors Domestic help Ragpickers Mechanics, electricians, repair workers Sanitation workers, gardeners, sweepers Cobblers, hawkers and others providing services by working on streets or pavements Plumbers, masons, construction workers, porters, welders, painters and security guards Transport workers like drivers, conductors, helpers, cart or rickshaw pullers Assistants, peons in small establishments, delivery boys, shopkeepers, and waiters The individuals who will not be the part of beneficiaries list are1. 2. 3. 4. 5. 6. 7. Those who own a two, three or four-wheeler or a motorized fishing boat Those who own mechanized farming equipment Those who have Kisan cards with a credit limit of Rs.50000 Those who are employed by the government Those who are working in a government-managed non-agricultural enterprise Those who are earning a monthly income above Rs.10000 Those who are owning refrigerators and landlines 8. Those who have a decent and solidly built houses 9. Those who own 5 acres or more of agricultural land Provisions and Benefits of Modicare 1. 2. 3. 4. 5. 6. 7. A beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empaneled hospitals across the nation. Both pre- and post-hospitalization expenses are covered under the scheme. It provides a boost to the concept of co-operative federalism by offering flexibility to states to decide their mode of implementation. Benefit cover has been increased to cover nearly 40% of the vulnerable population. It covers almost all secondary and many tertiary hospitalization procedures. The scheme will cover benefits up to Rs. 5 lakhs for each family with no restriction on the family size. It will help in reducing the incidence and impact of non-communicable diseases. The scheme covers a variety of serious ailments and critical diseases. Few of those covered under the scheme are Prostate cancer Coronary artery bypass grafting Double valve replacement Carotid angioplasty with stent Pulmonary valve replacement Skull base surgery Laryngopharyngectomy with gastric pull-up Anterior spine fixation Tissue expander for disfigurement following burns However, the scheme has the following Exceptions OPD Cosmetic related procedures Fertility related procedures Drug rehabilitation program Organ transplants Individual diagnostics (for evaluation) Shortcomings of Modicare scheme. 1. Transfer of Wealth: The biggest criticisms being leveled against Modicare is that it is not economically viable. Many economic experts believe that this scheme has been created only to gain political mileage. It is for this reason that the benefits are targeted towards a specific class of people who become the majority of the vote bank. This is where Modicare is in sharp contrast to Obamacare. Obamacare provided a universal health benefit to every American regardless of their economic status. Even the middle class was covered under Obamacare. On the other hand, Modicare specifically excludes the middle class. The plan is meant to only fund the lower class. The irony is that middle class is expected to pay the entire bill. Income tax revenues in India are largely generated by the middle class. However, they will not receive any benefits. Hence, it can be said that Modicare is a giant transfer of wealth scheme. It taxes the middle class to pay for the lower classes in order to achieve political gain. 2. Lack of Funding: Another major problem with Modicare is the lack of funding that the government has in place to fund a program of this magnitude. The Indian government has allocated 2 trillion rupees towards this scheme. This amount is woefully inadequate given that 50 billion individuals are going to be covered by this scheme. Hence, the government has budgeted only Rs. 40 per individual per annum. Obviously, the health insurance premiums are not that low. Hence, it is likely that the expenditure from this scheme will cause a drastic spike in the fiscal deficit. Once again, the comparison with Obamacare provides some context. In 2010, President Obama was of the opinion that providing healthcare to entire nation would cost the US government close to $940 million over a ten years period. However, within two years, the estimates were revised to $1100 billion. This gives an idea about the amount of expenditure required to sustain such a program. If we assume that the cost of providing healthcare in India is one-tenth as compared to the United States, the government is still woefully short of money. Hence, it seems to be only a political decision with little economic or financial backing. 3. Fragmented Healthcare System: Modicare is likely to face another major challenge. The fact of the matter is that healthcare is highly fragmented within the nation. The cost and quality of healthcare received vary widely depending upon the location. Hence, it would be difficult for the government to keep a check on whether the insurance claims they are paying out are genuine. Also, the hospitals that are being built in India are only in Tier-1 and Tier-2 cities. There are very limited healthcare facilities that are provided in smaller cities. It is for this reason that the government is likely to face problems in implementing this problem. They will face problems such as availability of healthcare professionals, distribution of medicines, etc. Mexico has already tried to implement a similar healthcare program. They have also faced the same difficulties since a majority of their population resides in rural areas whereas the majority of the healthcare infrastructure is in urban areas. 4. Healthcare Inflation: Healthcare inflation is closely linked to the percentage of the population that is insured. When people pay from their pockets, they are very cognizant of the costs that they are paying for different treatments. On the other hand, if the insurance company is paying, people stop comparing costs or even thinking about them. This is the reason why an increase in insurance coverage almost inevitably leads to an increase in healthcare costs. The United States has suffered from these increasing healthcare costs. Most Americans who do not have insurance are simply not able to afford healthcare. They often have to fly to other countries like India in order to obtain cost-effective healthcare. To sum it up, Modicare is a political program. The sole objective of the program is to garner political benefits for the ruling party. The program is neither morally correct nor economically feasible. It is a forceful redistribution of wealth from the middle class to the poor. The middle class now have to pay their own insurance premium as well as that of the people below poverty line. BRIEF (Silent Feature): 1. Ayushman Bharat – National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. per family per year. 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. Ayushman Bharat – National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the SECC database. The beneficiaries can avail benefits in both public and empanelled private facilities. To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis. One of the core principles of Ayushman Bharat – National Health Protection Mission is to co-operative federalism and flexibility to states. For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister. States would need to have State Health Agency (SHA) to implement the scheme. To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat – National Health Protection Mission to State Health Agencies may be done through an escrow account directly. In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless Merits of Scheme. A Strong Network of 1.5 Lakhs Health and Wellness Centers across the Country would constitute Foundation of India’s new Healthcare Systems. It will cover more than 10 Crore Poor and Vulnerable Families of the Society. The Support from Trained Nurses and Health Workers increase the Availability near Home in Rural Areas. Vulnerable Sections of the Society would have access to Healthcare to almost all medical and Surgical Conditions that can occur in Lifetime. 15. Package Rates decided by Government for Private Hospitals would help in keeping the cost low. 16. It will generate Employment Especially for Women would help in Economic Empowerment of Women. Challenges 1. Major Challenge would be Implementation and Governance of the Scheme. 2. The private hospitals are based on profitability motives and fixing rates of procedures would increase chances of hospitals neglecting poor Patients. The Healthcare is a goal under SDG 2030 Goal-3 of good health. The scheme would ensure proper healthcare facilities for most vulnerable sections of the society. 3. By preventive disease at early stage can make a change.For example, early detection of diabetes at the age of 35 can avoid the kidney failure at age of 50.Also schemes exclude outpatient health care that is responsible for 70% of health expenditure. 4. Budget allocation of 2000 crore scheme doesn’t serve the purpose.Amount is meager as compared to scope of the scheme. 5. The schemes is far from universal health coverage as it exclude 80 crore (60%) of the population.