MODICARE – 10 Benefits of National Health Protection Mission

modicare

Union Cabinet Approves Launch Of ‘Modicare’ For 10 Crore Families on Wednesday. Modi government’s ambitious Ayushman Bharat – National Health Protection Mission (NHPM) scheme promises to provide a universal health coverage and make health services equitable, affordable and accessible. It will benefit the poorest and the needy. “NHPM will cover over 10 crore poor families (approximately 50 crore people), providing a coverage of up to Rs 5 lakh. There is no limit on family size. This will be the world’s largest government-funded healthcare programme,” Union Health Minister JP Nadda said in a series of tweets.

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What is Modicare or Ayushman Bharat – National Health Protection Mission?

Ayushman Bharat, popularly known as Modicare and tagged as world’s largest government funded public health coverage, seeks to provide Rs. 5 lakh medical coverage per family per year to 10.74 crore poor and vulnerable families based on Socio Economic and Caste Census (SECC). It also proposes to strengthen the primary healthcare in the country with 150,000 health and wellness centres.

AB-NHPM, which will subsume the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS)., will take care of almost all secondary care and most of tertiary care procedures.

“One of the core principles of AB-NHPM is to co-operative federalism and flexibility to states,” said the statement. The states would be allowed to expand AB-NHPM both horizontally and vertically and they can implement through insurance company or Trust/Society or a mixed model.


What are the benefits of Modicare?

  • The scheme will provide a coverage of Rs 5 lakh per family per year and benefit more than 10 crore families belonging to the poor and vulnerable sections of the society.
  • To ensure that nobody is left out, especially women, children and the elderly people, there will be no cap on family size and age in the scheme.
  • The benefit cover will also include pre and post-hospitalisation expenses. All pre-existing conditions will be covered from day one of the policy, an official statement said.
  • The beneficiaries can 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 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
  • The AB-NHPM will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data, covering both rural and urban areas.
  • The different categories in the rural areas include families having only one room with “kucha” walls and “kucha” roof, families having no adult members among others. Also, automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour. For urban areas, 11 defined occupational categories are entitled under the scheme.
  • The scheme structure will ensure appropriate integration with the existing health insurance or protection schemes of various central ministries/departments and state governments (at their own cost). The state governments will be allowed to expand AB-NHPM both horizontally and vertically, the statement said.
  •  AB-NHPM will have a major impact on the reduction of Out Of Pocket (OOP) expenditure on the ground of an increased benefit cover to nearly 40 per cent of the population, which will lead to an increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to, the official statement said.
  • The Ayushman Bharat scheme will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus, leading to an improvement in the quality of life, the government said.

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