CONCEPT – FUNDING ISSUES WITH MODICARE

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CONCEPT – FUNDING ISSUES WITH MODICARE

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• Some states are out of it: Five states announced that they will not implement the government’s scheme due to some concerns. Telangana, Odisha, Delhi, Kerala and Punjab have opted out. Kerala has cast doubt on the scheme and its feasibility calling it a ‘big hoax’. Delhi too is out.
• Ambition  and objective: The scheme is ambitious, and funding is shared by the centre and states in a 60:40 ratio. The scheme is essentially an entitled based healthcare plan that targets the poor as identified by the latest SECC census. An individual who walks into an empanelled hospital can process cashless payments. This scheme offers Rs. 5 lakh per family for secondary care and tertiary care.
• Hospitals and packages: Various hospitals have agreed upon packaged rates under the scheme. Under PMJAY, there are about 1400 packaged rates for various medical procedures. Additional details that are provided for each package are number of average days of hospitalization for a medical procedure and supporting documents that are needed. Many hospitals complain of package rates being too low.
• The scale of the scheme: Given the desperate state of healthcare for poor in India, the new scheme aims at increasing the purchasing capacity among the poor. One way is financing services to keep prices low and affordable; another is by financing the paying capacity of the people. With a majority of healthcare in India situated in the private sector, pricing mechanisms are out of government control. So there are skeptics.
• Increasing public expenditure: A massive increase in public health expenditure, with a focus on primary health infrastructure, may be needed ultimately. The amount public expenditure on healthcare is minimal. The implementation of such an ambitious scheme will be tough. Thousands of entities across 31 states and union territories which have agreed to implement the scheme will be tasked with ensuring that Ayushman Bharat functions smoothly. The government, with the assistance of National Skill Development Corporation aims to train one lakh people or “Arogya Mitras” to run and implement the scheme.
• A chequered past: The complexities of such a plan are numerous and India has a chequered past when it comes health insurance schemes. During the Vajpayee government, the Institute of Health Systems (IHS), Hyderabad was commissioned to help develop a health insurance policy. As a result, in 2003, a Family Health Protection Plan (FHPP) was delivered. The main points were ambulatory primary care, out-patient consultation, clinical examination, curative services, and referrals. The predecessor to PMJAY was the Rashtriya Swasthya Bima Yojana (RSBY).
• In Sum: Finally, the essentials for a good healthcare scheme are – “Patients should not be under-treated, patients should not be over-treated with unnecessary procedures and patients should not be over-charged”.

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