Modicare : The decisive Game Changer
Organiser - Weekly   26-Mar-2018

Dr Ashish Barua

Healthcare in Bharat is a vast system and can be much like the rest of the countries, full of complexity and paradoxes. Bharat is a popular destination for medical tourists, given the relatively low costs and high quality of
its private hospitals.
Modicare is a dynamic and visionary initiative in health care by our Prime Minister Shri Narender Modi. It will give a mega change in Bharat’s health sector and will provide health facilities to innumerable citizens.
The Union Cabinet has given its nod for the launch of Modi government"s ambitious Ayushman Bharat - National Health Protection Mission (NHPM). The scheme promises to provide a universal health coverage and make health services equitable, affordable and accessible. It will benefit the poorest and the needy.
Private and Public
There is great discrepancy in the quality and coverage of medical treatment in our country. Healthcare between States and rural and urban areas can be vastly different. Rural areas often suffer from shortages of expert personnel and facilities. State governments provide healthcare services and health education, while the Central government offers administrative and technical services.
The lack of adequate coverage in the health care system in the country forces many people to turn to private healthcare providers. This option is generally inaccessible to the poor. To help pay for healthcare costs, insurance is available, often provided by employers, but most people lack health insurance, and out-of-pocket costs make up a large portion of the spending on medical treatment in the country.
On the other hand private hospitals in the country offer world class quality health care at a fraction of the price of hospitals in developed countries. This aspect of health care in Bharat makes it a popular destination for medical tourists. Bharat is a top destination for medical tourists seeking treatment in alternative medicine systems, such as Ayurveda.
Modicare- Extent and Expense
Modicare will provide a shot in the arm for the healthcare sector, increasing the insurance cover per family by over 1500 per cent from Rs 30, 000 under the extant Rashtriya Swasthya Bima Yojana (RSBY), to Rs 5 lakh. The Union Budget presented by Finance Minister Arun Jaitley on February 1, saw the unveiling of a mega healthcare project that is being touted as the world’s largest scheme of its kind, in both extent, and expense. The National Health Protection Scheme (NHPS), which has been dubbed ‘Modicare’ by the Finance Minister, has the objective of extending healthcare insurance to 100 million families, and raises the insurance ceiling to Rs 5 lakh per family.
The scheme will target up to 500 million individuals from financially vulnerable households, a demographic that accounts for 41.3 per cent of the population, according to Census data. Under the NHPS, four in every ten citizens can avail of secondary and tertiary care in government and private hospitals, within the insurance cap earmarked per family.
Secondary healthcare services include those provided by skilled medical practitioners, for outpatient treatment, or a brief stay at a hospital for serious illness. Tertiary care is for patients who are admitted to hospitals for longer bouts of illness, and require the attention of specialist doctors. Tertiary care is extended to patients who are suffering from acute pain, or terminal illness. A national health agency will be instituted under the scheme to oversee its implementation at the state-level. The identification of beneficiaries is to be done by consulting the 2011 round of the socio-economic caste census.
The Rashtriya Swasthya Bima Yojana (RSBY), which is the existing affordable-healthcare scheme, provides an insurance cover of Rs 30, 000 for a family comprising of at most five members. Out of the corpus earmarked for the scheme in the budget, the Central government pays 75 per cent of the expense, while the rest is borne by the States. The RSBY, which is the precursor to Modicare, is targeted at Below Poverty Line (BPL) families, and has been implemented in fifteen States.
The NHPS, which is modelled along the lines of Obama care, indicates the government’s intent to further the beneficiary pool for healthcare. “India cannot realise its demographic dividend without its citizens being healthy,” said Mr Jaitley in his budget speech. Ancillary to the NHPS, the government plans to set up 1.5 lakh Health and Wellness Centres under the Ayushman Bharat programme. These centres will provide treatment for non-communicable diseases, and disburse primary care to young mothers and children.
Challenges Ahead
In order to meet the demand for greater accessibility to healthcare, more Government Medical Colleges and Hospitals are planned to be instituted towards the goal of having at least one Medical College for every three Parliamentary constituencies. At present, there are 479 Medical Colleges affiliated to the Medical Council of India (MCI) as opposed to 543 Parliamentary constituencies. However, their spatial distribution is uneven, with more colleges being clustered around urban centres.
The number of doctors per lakh population is also below par. A World Health Organisation (WHO) report titled ‘The Health Workforce in India’ states that on an average, there are 79.7 doctors per one lakh people in the country. Chandigarh has the most doctors per capita with 279.9 doctors per lakh of the population. Meghalaya has only 27.5 doctors per lakh of the population. All the North-eastern States lag behind the national average in the number of healthcare professionals. Arunachal Pradesh and Nagaland have 32.5 and 35.6 doctors per lakh citizens respectively.
The healthcare scheme announced in the Budget will be a “game changer” for Bharat’s health industry and generate substantial growth in insurers’ premiums.
The insurance sector is slated to get a boost once the NHPS scheme is implemented as it reflects the government’s intent to expand the country’s protection umbrella, and could have far-reaching positive impact for the domestic insurance sector.
(The writer is a faculty member at National Law University, Jodhpur)