Modicare: Step Towards A Healthy India

Modicare is ready to be rolled out, but are insurance companies prepared?

- Suyash Desai and Nirmala Konjengbam

Government’s flagship National Health Protection Scheme (NHPS)also known as Ayushman Bharat Program and here after referred to as Modicare is all set to be rolled out on September 25. The scheme was launched in the Union Budget 2018 and will provide coverage of up to `5 lakh per family per year for secondary and tertiary care.

The Indian healthcare delivery system is categorised into two major components - public and private. The public healthcare system comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of Primary Health Centre (PHCs) in rural areas. The private hospitals provide majority of primary secondary and tertiary, care institutions with a major concentration in metros, tier I and tier II cities.

The scheme is set to cover 10 crore families, i.e almost 50 crore people (assuming five members per family). Apart from hospitalisation charges, the benefit will also include pre and post-hospitalisation expenses. Perks of the scheme are portable across the country and the beneficiary will be allowed to take cashless at the empanelled public and private hospitals, as noted in the release by government of India (GoI).

On March 2018, the Union Cabinet approved the continuation of National Health Mission with a budget of Rs 85,217 crore (US$ 13.16 billion) from April 1 2017 to March 31 2020. The government aims to increase the total health expenditure to 2.5 per cent of Gross Domestic Product (GDP) by 2025 from the current 1.15 per cent.

The beneficiaries will be based on deprivation criteria in the socio-economic caste census (SECC) database and the scheme will subsume existing central government sponsored schemes like Rashtriya Swasthya Bima Yojana and the Senior Citizen Health Insurance Scheme.

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