States May Merge Their Health Cover Schemes with Centre’s Ayushman Bharat

In a bid to provide greater coverage of health benefits to the poor, many states are contemplating joining hands with the Centre. They are likely to combine their existing health insurance programs with the Prime Minister’s Ayushman Bharat National Health Protection Mission (ABNHPM).

Which states are likely to merge with Ayushman Bharat scheme?
States such as Gujarat, Himachal Pradesh, Assam, Tamil Nadu, and Andhra Pradesh may merge with the PM’s ambitious scheme to provide health coverage to 100 million poor families and are expected to expand coverage under the existing state health schemes. According to ABNHPM CEO Indu Bhushan, Gujarat, Tamil Nadu and Andhra Pradesh are expected to sign memoranda of understanding (MoUs) with the Centre to this effect this month. Himachal Pradesh and Assam signed such agreements in May, he said. The merging would happen in a way that key features of both schemes will be retained, he added. “A large number of states have their own schemes covering more than the number of beneficiaries we are proposing,” he told the paper in an interview. “In those cases, we are asking the states to combine the two schemes, taking the key features of ABNHPM like coverage for ₹5 lakh, national portability, unified IT framework and coverage of all SECC (socio-economic and caste census) eligible beneficiaries.”

How will the merger help?
Merging of the state health scheme with the centre’s will provide greater coverage as none of the state schemes offer as much as ₹5 lakh coverage so far. A merger will allow patients to avail the scheme’s benefits in different states through the national portability feature and may also expand the number of treatment packages in some of states currently offering 700-800 treatments, Bhushan said. In case the package rates offered under existing schemes are higher than the ABNHPM rates, states are at liberty to revise the Centre’s proposed rates to match their own, Bhushan said. Rajasthan, Himachal Pradesh, Tamil Nadu, Kerala, Andhra Pradesh, Karnataka and Assam have their own health schemes.

Tamil Nadu is waiting for formal approval to combine its own comprehensive health insurance scheme with ABNHPM, but will “hopefully” sign an agreement this week along with Gujarat, which is ready with its MoU, said Bhushan. “Andhra Pradesh has a trust already. For them, it is a question of increasing coverage to ₹5 lakh, expanding treatment packages and including national portability.” Madhya Pradesh, Uttar Pradesh, Bihar, Jharkhand and Chhattisgarh, which don’t have their own state schemes, are expected to sign agreements this week after finalising if they will implement ABNHPM through a private insurance or trust mode, he said.

More about Ayushman Bharat scheme and the merger
The MoUs signed by the states will list the obligations of the Centre and the states and the timelines to be followed to ensure states are prepared for an August 15 rollout of the scheme. So far, 10 states and Union Territories without their own health protection schemes have already signed such MoUs, he told ET. A third of the states and UTs have settled on a trust model to implement ABNHPM, including Bihar, which was earlier considering the private insurance route, according to Bhushan. “Many state-sponsored health insurance schemes are already covering extensive range of packages proposed under Ayushman Bharat with family coverage of ₹1-1.5 lakh. The increased coverage to ₹5 lakh per family per year is mainly to attract high-end corporate hospitals into the scheme,” said Indranil Mukhopadhyay, associate professor at OP Jindal Global University School of Government and Public Policy. “However, it is highly unlikely that in one family, there would be more than one person needing high expenditure packages in the same year.” According to him, a more significant contribution of the Ayushman Bharat program is its health and wellness centres, which seek to provide access to medicines and diagnosis at the grassroots level. Current allocation to these centres is meagre and needs to be significantly increased, he said. – Money Control

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