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<ul><li><keyword id="43945" type="COMPANY" weightage="20" keywordseo="Chhattisgarh">Chhattisgarh</keyword> has become the latest state to exit the central government’s <keyword id="6199405" type="UNKNOWN" weightage="20" keywordseo="ayushman-bharat">Ayushman Bharat</keyword> <keyword id="35450" type="COMPANY" weightage="20" keywordseo="insurance">insurance</keyword> scheme. </li><li>In addition to <keyword id="6357783" type="UNKNOWN" weightage="20" keywordseo="West-bengal">West Bengal</keyword> and Chhattisgarh, the non-BJP ruled states of Odisha, Telangana as well as Delhi have also rejected the scheme. </li><li>All of these states either have plans to or have already started their own health insurance coverage schemes.</li></ul>The central Indian state of Chhattisgarh has become the latest state to exit the central government’s Ayushman Bharat insurance scheme. The state’s health minister, T S Singhdeo, said that the government would instead offer its <a href="https://indianexpress.com/article/india/chhattisgarh-to-move-towards-universal-healthcare-plan-t-s-singhdeo-5543794/">own universal healthcare scheme</a> featuring free medicines, outpatient care, and improved public health infrastructure via an existing network. In addition to West Bengal and Chhattisgarh, the non-BJP ruled states of Odisha, Telangana as well as Delhi have also rejected the scheme. All of these states either have plans to or have already started their own health insurance coverage schemes. Delhi, in particular, took a similar line as West Bengal in that it objected to how the scheme was being branded as mainly a central government programme. The common thread across these states rejecting the programme is that they are ruled by the rivals of <keyword id="6354642" type="PERSON" weightage="20" keywordseo="Modi">Modi</keyword>’s Bharatiya Janata Party (BJP). However, that is not the only challenge. The national health insurance scheme was rolled out at the end of September last year, with the stipulated aim of covering 110 million families to the tune of half a million rupees a year. Around <a href="https://timesofindia.indiatimes.com/india/ayushman-bharat-a-game-changer-6-85-lakh-patients-treated-in-100-days-jaitley/articleshow/67335634.cms">685,000</a> patients had reportedly availed of the scheme by the end of 2018, according to Finance Minister Arun Jaitley. As the minister from Chhattisgarh explained, Ayushman Bharat provided insurance for secondary and tertiary <keyword id="6354525" type="UNKNOWN" weightage="20" keywordseo="healthcare">healthcare</keyword> in hospitals, whereas <a href="https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/chhattisgarh-govt-to-pull-out-of-ayushman-bharat/articleshow/67550227.cms">nearly 80%</a> of the state’s citizens required primary healthcare services. Outpatient treatment, which is hugely popular with India’s poor households according to <a href="https://www.brookings.edu/wp-content/uploads/2016/12/201612_health-and-morbidity.pdf">a Brookings report</a>, isn’t provided under the scheme. In addition, as public hospitals lack the requisite infrastructure, the government is relying heavily on private hospitals, which aren’t that widespread in semi-urban and rural areas and can promote expensive treatments to improve their margins. The programme is not well funded either. The central government will have to increase its annual funding for the scheme as its ₹20 billion allocation in the 2018 Budget is insufficient - <a href="https://www.livemint.com/Politics/kYhU6jUzQHcz4gexCpVUQP/Confident-of-getting-more-funds-for-Ayushman-Bharat-CEO-Ind.html">a view echoed </a>by the CEO of the programme, Indu Bhushan. As of end-December 2018, the central government had already authorised <a href="https://www.thehindubusinessline.com/money-and-banking/centre-has-spent-850-crore-on-ayushman-bharat-till-date/article25836102.ece">₹8.5 billion </a>worth of claims. A higher allocation will likely be unveiled in the government's interim budget on February 1st. Whose insurance is it anyway The state of West Bengal, which merged its own health protection programme Swastyasathi with Ayushman Bharat last year, also pulled out of the scheme. Chief minister Mamata Banerjee rationalised the move by citing the central government’s attempts<a href="https://indianexpress.com/article/india/mamata-banerjee-pulls-out-of-pmjay-ayushman-bharat-scheme-says-centre-taking-credit-5532864/"> to take full credit</a> for what was essentially a joint effort, wherein the state government shared 40% of the cost. While the states’ pull-out will affect the momentum and portability of the national programme, it also indicates the problems associated with its implementation. Granted, it's only been a little over 100 days since the scheme came into operation, but the gaps in the plan are already evident. SEE ALSO: <a href="https://www.businessinsider.in/indias-insurers-are-being-left-out-of-the-countrys-national-health-insurance-scheme/articleshow/65422864.cms">India’s insurers are being left out of the country’s national health insurance scheme</a> <a href="https://www.businessinsider.com/r-india-allocates-15-billion-for-modicare-health-insurance-2018-3">India allocates $1.5 billion for 'Modicare' health insurance</a>

India's 'Modicare' insurance scheme needs some fixing

<ul><li>Currently, <keyword id="3658" type="LOCATION" weightage="20" keywordseo="India">India</keyword> spends only 1.2% of its GDP on <keyword id="6354525" type="UNKNOWN" weightage="20" keywordseo="healthcare">healthcare</keyword>. </li><li>the government has passed the National <keyword id="6354750" type="UNKNOWN" weightage="20" keywordseo="health">Health</keyword> Policy (NHP) to increase the public healthcare spending to 2.5% of the GDP with a special focus on the underprivileged. </li><li>Once launched <keyword id="344159" type="ORGANIZATION" weightage="20" keywordseo="MODICARE">Modicare</keyword> will be world's largest government-run insurance scheme of its kind. </li></ul>India spends only 1.2% of its GDP on healthcare. And with that figure, the country ranks in lower than Singapore that has one of the lowest public health expenditures in the world at 2.2% amongst countries with significant United Health Care (UHC) services. If that 1.2% was not a figure dismal enough, India spends<a href="https://data.worldbank.org/indicator/MS.MIL.XPND.GD.ZS"> 2.5%</a> of its GDP for military purposes. It is time the country resets its priorities. With<a href="https://www.businessinsider.in/healthcare-costs-drove-55-million-indians-below-poverty-line-in-the-last-two-decades/articleshow/64573439.cms"> 55 million Indians</a> falling below the poverty line in a single year because of heavy medical expenses and no help from the government, the poor also have very little to choose from when it comes to public and private healthcare. While public healthcare maybe the best that they can afford, the standards of public hospitals are deplorable, and private facilities are far too expensive. India's per capita public expenditure on health was as low as ₹621 in 2009-10. Though it increased to ₹1,112 ($16) in 2015-16, it seems almost absurd when compared to countries like the US and the UK with expenditures of $4,802 and $3,500 respectively. But perhaps, things can change now. To make the situation better, the government has finally passed the National Health Policy (NHP) which commits to spending 2.5% of the GDP on healthcare with a special focus on the underprivileged. Dr Ravi Wankhedkar told <a href="https://timesofindia.indiatimes.com/city/chandigarh/govt-spends-only-1-2-of-gdp-on-healthcare-in-india/articleshow/60963195.cms" data-type="tilCustomLink">The Times of India</a> that the national president of Indian Medical Association (IMA) for 2018, the spending should have been raised to at least 5%. NHP will also extend its focus on shifting from “sick care” or cure to “wellness” or prevention. The policy further promises to venture into a new concept of “strategic purchasing” from the private sector to achieve the national health goals. It also has envisioned targets to reduce the Maternal Mortality Ratio, and Infant Mortality Rate significantly. The situation may improve even further with the <keyword id="3664127" type="PERSON" weightage="20" keywordseo="National-Health-Protection-Scheme">National Health Protection Scheme</keyword> (NHPS) that the government is planning to launch soon. The scheme plans to target over 100 million poor families with an annual health cover of ₹0.5 million per family. Often called Modicare, once it is launched, will be world's largest government-run insurance scheme of its kind. According to the health minister, <a href="https://timesofindia.indiatimes.com/topic/JP-Nadda">JP Nadda</a>, the scheme will be able to significantly bring down the citizen’s ‘out of pocket’ expenditure on health, which pushes millions of Indians below the poverty line every year. India’s ‘out of pocket’ expenditure currently stands on 67.78% against the the world average of 18.2%, according to WHO. Though the schemes seem progressive, they have been strongly <a href="http://www.thehindu.com/news/national/centre-cleared-the-long-awaited-national-health-policy-2017/article17487845.ece">criticised by activists</a> because it scrapped a section of the final draft which proposed to make health a fundamental right. They believe that the failure to provide healthcare should have serious legal consequences and without that provision, the policy remains a hollow promise.

India spends just 1.2% of its GDP on healthcare, but a policy can change that

Introduced by the Prime Minister Narendra Modi, the health insurance scheme with a grand vision is named as <keyword id="6199405" type="UNKNOWN" weightage="20" keywordseo="ayushman-bharat">Ayushman Bharat</keyword> providing the subscribers a medical expenses cover of up to Rs 5 lakh. Here is what you must know about the scheme and the eligibility criteria that will help you benefit from the scheme. Called by other names such as the National Health Protection Mission (AB-NHPM) or Modicare, this government-sponsored health insurance scheme offers free coverage of up to Rs 5 lakh per family per year for medical care availed of at any government hospital or an empanelled medical care facility in India. The scheme is meant only for poor families and the economically deprived segments of the society. The scheme aims to cover about 10.74 crore beneficiary families and around 50 crore Indian citizens. Key aspects of <keyword id="6199968" type="UNKNOWN" weightage="20" keywordseo="Ayushman-Bharat-scheme">Ayushman Bharat scheme</keyword> The medical insurance cover will provide a maximum of about Rs 5 lakhs per family per year on secondary as well as tertiary medical care availed of from medical facilities. Eligibility is strictly based on the Socio-Economic Caste Census (SECC) database and those that are eligible will be covered by the program automatically without having to register for it. If a person from an eligible family is hospitalized, the family need not spend on the treatment when they visit a government or an empanelled private hospital for treatment. The policy covers all kinds of diseases and the benefit offers coverage both for pre and post hospitalization expenses. Unlike other kinds of medical insurance schemes, there is no waiting period for pre-existing ailments. Though Aadhaar card is not a mandated requirement for availing of the medical care under the Ayushman Bharat scheme, the beneficiaries will have to produce a prescribed ID at the hospital to receive free treatment. Eligibility criteria for Ayushman Bharat scheme in rural areas 1. Families inhabiting a single room or a domicile with “kuchcha walls and kuchcha roof" 2. Families in which there is no adult member in the age group 16 and 59 3. Family headed by a female with no adult male member belonging to the 16-59 age group 4. Families in which there is at least one disabled member and no able-bodied adult member 5. SC/ST households 6. Landless households making a majority of their earnings from manual casual labour 7. Extremely poor and those individuals surviving on alms 8. Families of manual scavengers 9. Families belonging to primitive tribal groups Eligibility criteria for Ayushman Bharat scheme in urban areas As per the guidelines issues as part of the Ayushman Bharat scheme, the following 11 occupational categories of workers are included in the list automatically. 1. <keyword id="6470258" type="UNKNOWN" weightage="20" keywordseo="Domestic-worker">Domestic worker</keyword> 2. Street vendor, cobbler, hawker, and other service providers working on the streets 3. Construction worker, plumber, mason, labour, painter, welder, security guard, coolie and other head-load workers 4. Sweeper, sanitation worker, and gardener 8. Home-based worker, artisan, handicrafts worker, and tailor 9. Transport worker, driver, conductor, helper to drivers and conductors, cart puller, and rickshaw puller 10. Shop worker, assistant, peon in small establishment, helper, delivery assistant, attendant, and waiter 11. Electrician, mechanic, assembler, and repair worker 12. Washer-man, and chowkidar 13. Homeless people

What is Prime Minister health insurance scheme?

<ul><li><keyword id="3658" type="COUNTRY" weightage="20" keywordseo="India">India</keyword>, a country of 29 states, is finally en route to implementing universal patient’s right in the country. </li><li>The <keyword id="6354960" type="ORGANIZATION" weightage="20" keywordseo="national-human-rights-commission">National Human Rights Commission</keyword> (NHRC) publish a draft of the ‘Charter of Patients Rights’, which not only highlight individual entitlements but also responsibilities that go hand-in-hand. </li><li>While some of these rights may seem obvious, historical examples highlight their urgent need.</li></ul>One of the biggest economies in the world is still struggling with the basics of healthcare. India, where the medical tourism sector is rapidly growing, has patients come in from all over the world yet lacks a universal policy on patient’s rights. On Tuesday, the Health Ministry released a draft of the <a href="https://www.mohfw.gov.in/newshighlights/draft-patient-charter-prepared-national-human-rights-commission">‘Charter of Patient Rights’</a> collated by the National Human Rights Commission (NHRC). 
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 Currently, some states adhere to the Clinical Establishments Act 2010 while others have their own unique legislation in place for the regulation of hospitals. The Charter of <keyword id="3014312" type="PERSON" weightage="20" keywordseo="patient-rights">Patient Rights</keyword> not only lists out the rights of every patient but also their responsibilities so that doctors can do their job. 
 
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 In addition to establishing the legislation, the charter also proposes setting up a grievance redressal mechanism where hospitals and doctors can be reported and held accountable should there be any violations. The right to non-discrimination Caste, creed, gender or even medical conditions cannot be the basis for discrimination when patients go looking for treatment. It’s not only the practitioners who have to adhere to this, but the hospital management is also responsible for seeing that these rights are being enforced. Historical <a href="http://ijme.in/articles/reflections-on-discrimination-and-health-in-india/?galley=html">examples</a> of discrimination not only outline cases where medical care has been subpar or refused altogether, but where patients have been taken advantage of in order to have access to basic check-ups. Incidences vary in intensity, temporality and even dimensions. The right to informed consent While this should be a fundamental right, the confusion lies in situations where the patient is unconscious or under heavy medication. Because even with complete patient autonomy in some countries, they are still extremely hesitant to accept the concept of active euthanasia. And, that’s where <a href="http://ijme.in/articles/informed-consent-legal-and-ethical-aspects/?galley=html">‘valid consent’</a> comes in. Most public hospitals in India make patients sign a consent form when they are admitted which basically states that the doctor can perform any treatment that he deems fit. But, the legality there is questionable. Currently, Indian courts follow the concept of ‘true consent’ where the process is biased towards the doctors. In comparison, western courts follow the ‘reasonable patient’ approach. Right to transparency in rates It was only last year in KPMG International’s <a href="https://www.thehindubusinessline.com/economy/india-fares-poorly-on-transparency-finds-kpmg-healthcare-report/article9637907.ece">report</a> that India was second-to-last in terms of transparency in the healthcare system. The issue isn’t just that patients get overcharged for treatments, but at times they don’t even know what they’re paying for. Right to safety and quality care According to a <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.0676">study</a> published in Health Affairs, even globally acclaimed hospitals in India have facilities that extremely low in quality. That being said, it’s not a challenge that’s unique to India. Developing and developed countries alike face quality issues due to geographic variations, medical errors etc. While quality care has normally been linked to infrastructural constraints, recent studies have shown that more than the availability of clinical establishments, the issue lies in the knowledge base of healthcare providers. While they may believe they are providing high-quality services, it’s their lack of capacity or knowledge that renders the sub-par quality of the health system. The Draft of Patient’s Rights aims to address these problems at a fundamental level. The charter comes days ahead of the launch of India’s universal health scheme, Ayushman Bharat. <keyword id="6854027" type="UNKNOWN" weightage="20" keywordseo="universal-patient-rights">Universal patient rights</keyword> in cohesion with, what some call, Modicare are the push that the Indian healthcare sector needs to improve. That being said, as ambitious as these plans are, they will only be successful if implemented with greater clarity.

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India's 'Modicare' insurance scheme needs some fixing

Dilsher Dhillon

India spends just 1.2% of its GDP on healthcare, but a policy can change that

BI India Bureau

What is Prime Minister health insurance scheme?

BI India Bureau

The need for universal patient rights in India

Prabhjote Gill

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