PM Modi's flagship health scheme 'Modicare' helped in winning votes & hearts, according to reports. Watch this video to know more.

PM Modi's health scheme 'Modicare' helped in winning votes & hearts

Pradhan Mantri Jan Arogya Yojana, aka ‘Modicare’, Ayushman’s most comprehensive component, has been projected as the biggest health programme in the world even before it was implemented. The scheme, like its earlier avatars Rashtriya Swasthya Beema Yojana (RSBY) or several government-funded health insurance (GFHI) schemes run by state governments, promises to provide free hospitalisation care for the poor and marginal sections.&nbsp;

Without taking claims too seriously, it can be safely said that this is the biggest Public Private Partnership (PPP) effort in healthcare in India.&nbsp;

The scheme essentially subsidises hospitalisation expenses in private sector with tax money to help access a large market and thus boost private sector growth in health care — all in the name of free hospitalisation care for the poor.

Experience of RSBY and other state insurance schemes shows that free care remains elusive, particularly when care is sought at private hospitals. Out of every 100 hospitalisation cases under various government-sponsored health insurance schemes, only three get free care. People need to pay a lot if they seek care in private hospitals — more than half spend Rs 10,000 or more. In contrast, if one goes to a public hospital, more than half of them spend Rs 1,000 or less.

Coverage against hospitalisation cost up to Rs 5 lakh, increasing it from Rs 30,000 under RSBY is being seen as a major step forward to ensure that care is given free. Some existing state schemes have coverage of up to Rs 1.5 to Rs 2 lakh per family, without much effect on financial protection. So increasing coverage really doesn’t mean much.&nbsp;

Designing specific elements of the schemes — whether to involve insurance companies or go for a trust model is left to states. States in central and east and north-east are not expected to gain from this supposed partnership with private sector.&nbsp;

The reality of our country is that most private hospitals have either grown in and around public hospitals or in metro cities, state capitals and other big cities in the south, north and western part of the country.&nbsp;

Almost half of the private hospitals and two-thirds of corporate hospitals are in few five million-plus cities, where bigger government hospitals and medical colleges are also available. There are hardly any private hospitals in rural areas and in remote parts of the country. Vast majority of the people in these settings depend on either government hospitals or the few not-for-profit charitable hospitals.

Compared to insurance agencies, trusts have greater control over the claim settlement process and could be a better model in terms of reducing the role of the intermediaries and thus reduce the likelihood of siphoning off the profit.&nbsp;

However, many of these states neither have the capacity to effectively negotiate with private providers, insurance agencies nor the technical capabilities to run a trust model on their own.

Numerous incidents of unethical practices, overcharging, unnecessary care and in rare extreme situations, deaths due to medical negligence and denial of care point out that medical care market cannot be left to itself. This calls for comprehensive regulation of clinical standards as well as prices.&nbsp;

Though we have a Clinical Establishment Act, most states have not ratified the Act. Furthermore, the Act, in the current form, does not talk about regulation of prices or rationalisation of trade margins.&nbsp;

When the government came up with procedure rates, there was considerable hue and cry among the industry and medical associations that prices are very low and would thus compromise on the quality of care. Though this reaction is understandable as a strategy to negotiate for higher prices, one needs to appreciate the dangers of such partial regulation of prices.&nbsp;

The vast majority of the country’s population, particularly the informal non-poor, are neither covered by any government health protection scheme, nor can they afford private health insurance. This section is finding it increasingly difficult to bear health-care expenses in the private sector.&nbsp;

The private sector is likely to charge higher prices from the patients who are not covered by the GFHIs in order to cross-subsidise the lower rates provided by GFHIs.&nbsp;

Possibilities of charging additional fees from patients with coverage in the name of quality also exist. &nbsp;

There have been numerous efforts to forge PPPs in the health sector to help the expansion of the private sector – often at the cost of public services.&nbsp;

However, the objective of orienting private health care sector to public goals has remained largely unfulfilled. As the private sector gets more organized and big hospitals chains start to dominate the market, which is inevitable without regulation and no expansion of government services, it would be increasingly difficult for governments to intervene.&nbsp;

There would be further lobbying for higher prices under GFHIs, insurance premiums would go up and governments and patients would have little choice but to accept their demand. It may not be far that PMJAY becomes truly the biggest scheme in the world in terms of how much money it consumes while the majority of the population continue to find access to quality health care unaffordable. But does anyone care?

(This article was originally published on DNA. Read the <a href="https://www.dnaindia.com/analysis/column-ayushman-roadblocks-ahead-2684412">original article</a>)

(Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

&nbsp;

Pradhan Mantri Jan Arogya Yojana, aka ‘Modicare’, Ayushman’s most comprehensive component, has been projected as the biggest health programme in the world even before it was implemented.

Pradhan Mantri Jan Arogya Yojana, aka ‘Modicare’, Ayushman’s most comprehensive component, has been projected as the biggest health programme in the world even before it was implemented. The scheme, like its earlier avatars Rashtriya Swasthya Beema Yojana (RSBY) or several government-funded health insurance (GFHI) schemes run by state governments, promises to provide free hospitalisation care for the poor and marginal sections. Without taking claims too seriously, it can be safely said that this is the biggest Public Private Partnership (PPP) effort in healthcare in India. The scheme essentially subsidises hospitalisation expenses in private sector with tax money to help access a large market and thus boost private sector growth in health care — all in the name of free hospitalisation care for the poor. Experience of RSBY and other state insurance schemes shows that free care remains elusive, particularly when care is sought at private hospitals. Out of every 100 hospitalisation cases under various government-sponsored health insurance schemes, only three get free care. People need to pay a lot if they seek care in private hospitals — more than half spend Rs 10,000 or more. In contrast, if one goes to a public hospital, more than half of them spend Rs 1,000 or less. Coverage against hospitalisation cost up to Rs 5 lakh, increasing it from Rs 30,000 under RSBY is being seen as a major step forward to ensure that care is given free. Some existing state schemes have coverage of up to Rs 1.5 to Rs 2 lakh per family, without much effect on financial protection. So increasing coverage really doesn’t mean much. Designing specific elements of the schemes — whether to involve insurance companies or go for a trust model is left to states. States in central and east and north-east are not expected to gain from this supposed partnership with private sector. The reality of our country is that most private hospitals have either grown in and around public hospitals or in metro cities, state capitals and other big cities in the south, north and western part of the country. Almost half of the private hospitals and two-thirds of corporate hospitals are in few five million-plus cities, where bigger government hospitals and medical colleges are also available. There are hardly any private hospitals in rural areas and in remote parts of the country. Vast majority of the people in these settings depend on either government hospitals or the few not-for-profit charitable hospitals. Compared to insurance agencies, trusts have greater control over the claim settlement process and could be a better model in terms of reducing the role of the intermediaries and thus reduce the likelihood of siphoning off the profit. However, many of these states neither have the capacity to effectively negotiate with private providers, insurance agencies nor the technical capabilities to run a trust model on their own. Numerous incidents of unethical practices, overcharging, unnecessary care and in rare extreme situations, deaths due to medical negligence and denial of care point out that medical care market cannot be left to itself. This calls for comprehensive regulation of clinical standards as well as prices. Though we have a Clinical Establishment Act, most states have not ratified the Act. Furthermore, the Act, in the current form, does not talk about regulation of prices or rationalisation of trade margins. When the government came up with procedure rates, there was considerable hue and cry among the industry and medical associations that prices are very low and would thus compromise on the quality of care. Though this reaction is understandable as a strategy to negotiate for higher prices, one needs to appreciate the dangers of such partial regulation of prices. The vast majority of the country’s population, particularly the informal non-poor, are neither covered by any government health protection scheme, nor can they afford private health insurance. This section is finding it increasingly difficult to bear health-care expenses in the private sector. The private sector is likely to charge higher prices from the patients who are not covered by the GFHIs in order to cross-subsidise the lower rates provided by GFHIs. Possibilities of charging additional fees from patients with coverage in the name of quality also exist. There have been numerous efforts to forge PPPs in the health sector to help the expansion of the private sector – often at the cost of public services. However, the objective of orienting private health care sector to public goals has remained largely unfulfilled. As the private sector gets more organized and big hospitals chains start to dominate the market, which is inevitable without regulation and no expansion of government services, it would be increasingly difficult for governments to intervene. There would be further lobbying for higher prices under GFHIs, insurance premiums would go up and governments and patients would have little choice but to accept their demand. It may not be far that PMJAY becomes truly the biggest scheme in the world in terms of how much money it consumes while the majority of the population continue to find access to quality health care unaffordable. But does anyone care? (This article was originally published on DNA. Read the original article) (Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

Roadblocks ahead for Ayushman Bharat scheme

The acute shortage of qualified medical professionals in rural India may impact the relaunch of 150,000 health sub-centres and primary health centres (PHCs) as “health and wellness centres” under Ayushman Bharat Yojana, the national health scheme launched on September 23, 2018.

A lesser known part of the health insurance programme, also called ‘Modicare’, comprises health and wellness centres that will have a critical role in controlling the growing burden of non-communicable diseases in India. They will also offer maternal and child health services. The problem is that sub-centres, run by a team of an auxiliary nurse midwife, a male multi-skilled health worker and health assistants, are short of staff while primary health centres do not have enough doctors:

Of the 156,231 sub-centres in India, 78,569 were without male health workers, 6,371 without auxiliary nurse midwives and 4,263 without either, according to Rural Health Statistics, 2017.

PHCs require 25,650 doctors across India to tend to a minimum of 40 patients per doctor per day for outpatient care, as per Indian Public Health Standards (IPHS). If these standards are met, 1 million patients could be benefit everyday. But with a shortage of 3,027 doctors, 1,974 PHCs are without doctors. This means that 12 per cent, or 121,080 patients, go without access to primary healthcare everyday.

Healthcare in India’s villages is a three-tier structure under the National Rural Health Mission (NRHM): Sub-centres, primary health centres and community health centres.&nbsp;

Sub-centres are at the forefront, covering 5,000 people in the plains and 3,000 in hill or tribal areas. PHCs are equally important for the Ayushman Bharat Yojana to succeed because they are the first link to a consultation with a medical doctor and act as referral points for specialist consultations at community health centres.

Strengthening both the PHCs and sub-centres will ease the burden on secondary and tertiary health institutions.

Failure to find enough doctors will also set back universal health coverage as envisioned by successive National Health Policies in 2002 and 2017.

Seventy per cent of India’s population lives in villages and 30 per cent in urban areas. But the distribution of health workers leaves rural India with little access to healthcare — 60 per cent of the country’s 2 million strong health workforce caters to urban India, only the remaining 40 per cent services villages, as per data from a 2016 World Health Organisation (WHO) report.

There is another issue the proposed centres will have to deal with: Health-workers practising in both urban and rural areas of India are not adequately qualified, as per the WHO study. Among urban and rural allopathic doctors, only 58 and 19 percent doctors, respectively, were medically qualified.&nbsp;

As for nurses and midwives practising in rural areas, only 33 per cent have studied beyond secondary school and 11 per cent have medical qualification, the report estimated.

A perception survey of patients who visited healthcare facilities more than once showed that 43 per cent patients, on average, across four states were not satisfied with the medical treatment provided by the health facilities.Of the patients surveyed, 34 per cent complained of staff absenteeism, 32 per cent of shortage of medicines, 13 per cent &nbsp;of long waits; 3 per cent said centres were shut, 2 per cent claimed that there were no facilities at all and the remaining 5 per cent alleged different acts of corruption, according to the 2011 report by the High Level Expert Group on Universal Health Coverage.

A potential area of concern for the new wellness centres could be the reliance of rural patients on non-degree allopathic practitioners (NDAPs), or practitioners without an MBBS, according to a study carried out in Uttar Pradesh and Bihar.&nbsp;

Studies in rural Karnataka, Andhra Pradesh and Odisha have shown reliance on private practitioners for multiple reasons. The biggest of these is the lack of easy access to public health facilities: 73 per cent sub-centres were more than 3 km from patients, 28 per cent sub-centres and 20 per cent PHCs were not accessible by public transport, concluded an IndiaSpend analysis of a Comptroller and Auditor General report.

The easy availability and proximity of an NDAP allowed for faster consultation, according to this 2014 study carried out in north India. “Embedded in the community, the NDAPs have adapted their services to people’s needs, preferences and economic capabilities”, making them the preferred resource for “all-in-one” services, the study said.

Poor living and working conditions, irregular drug supply, weak infrastructure, professional isolation and the burden of administrative work: These are some of the challenges faced by doctors on rural postings, stated a 2017 study by the Public Health Foundation of India.

As of 2018, India has 497 medical colleges registered with the Medical Council of India (MCI) that together offer an intake capacity of 60,680 seats for MBBS. Trends in India, as well as other BRICS nations such as South Africa, suggest that most doctors prefer to sign up for hospital-based specialisations in urban areas than get into general practice at PHCs, a 2015 study published in Human Resources for Health observed.

To address this, policy frameworks in several states have mandated compulsory rural service of 1-5 years during postgraduate medical studies. Further, some states require medical officers to practise medicine in rural areas for a particular period after postgraduate studies.

Mid-level health providers could be the solution to the shortage of doctors in rural areas, according to this report of a national consultation on strengthening rural healthcare, 2018.

“A key challenge that India faces is that even after diagnosis, people continue to use health care services in secondary and tertiary settings, for conditions which can be managed at the primary care level,” said Chandrakant Lahariya, the national professional officer, Universal Health Coverage, WHO.&nbsp; 
 
(This article was originally published on DNA. Read the <a href="https://www.dnaindia.com/analysis/column-ways-to-make-modicare-work-2678897">original article</a>)

(Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

The acute shortage of qualified medical professionals in rural India may impact the relaunch of 150,000 health sub-centres and primary health centres (PHCs) as “health and wellness centres” under Ayushman Bharat Yojana, the national health scheme launched on September 23, 2018.

The acute shortage of qualified medical professionals in rural India may impact the relaunch of 150,000 health sub-centres and primary health centres (PHCs) as “health and wellness centres” under Ayushman Bharat Yojana, the national health scheme launched on September 23, 2018. A lesser known part of the health insurance programme, also called ‘Modicare’, comprises health and wellness centres that will have a critical role in controlling the growing burden of non-communicable diseases in India. They will also offer maternal and child health services. The problem is that sub-centres, run by a team of an auxiliary nurse midwife, a male multi-skilled health worker and health assistants, are short of staff while primary health centres do not have enough doctors: Of the 156,231 sub-centres in India, 78,569 were without male health workers, 6,371 without auxiliary nurse midwives and 4,263 without either, according to Rural Health Statistics, 2017. PHCs require 25,650 doctors across India to tend to a minimum of 40 patients per doctor per day for outpatient care, as per Indian Public Health Standards (IPHS). If these standards are met, 1 million patients could be benefit everyday. But with a shortage of 3,027 doctors, 1,974 PHCs are without doctors. This means that 12 per cent, or 121,080 patients, go without access to primary healthcare everyday. Healthcare in India’s villages is a three-tier structure under the National Rural Health Mission (NRHM): Sub-centres, primary health centres and community health centres. Sub-centres are at the forefront, covering 5,000 people in the plains and 3,000 in hill or tribal areas. PHCs are equally important for the Ayushman Bharat Yojana to succeed because they are the first link to a consultation with a medical doctor and act as referral points for specialist consultations at community health centres. Strengthening both the PHCs and sub-centres will ease the burden on secondary and tertiary health institutions. Failure to find enough doctors will also set back universal health coverage as envisioned by successive National Health Policies in 2002 and 2017. Seventy per cent of India’s population lives in villages and 30 per cent in urban areas. But the distribution of health workers leaves rural India with little access to healthcare — 60 per cent of the country’s 2 million strong health workforce caters to urban India, only the remaining 40 per cent services villages, as per data from a 2016 World Health Organisation (WHO) report. There is another issue the proposed centres will have to deal with: Health-workers practising in both urban and rural areas of India are not adequately qualified, as per the WHO study. Among urban and rural allopathic doctors, only 58 and 19 percent doctors, respectively, were medically qualified. As for nurses and midwives practising in rural areas, only 33 per cent have studied beyond secondary school and 11 per cent have medical qualification, the report estimated. A perception survey of patients who visited healthcare facilities more than once showed that 43 per cent patients, on average, across four states were not satisfied with the medical treatment provided by the health facilities.Of the patients surveyed, 34 per cent complained of staff absenteeism, 32 per cent of shortage of medicines, 13 per cent of long waits; 3 per cent said centres were shut, 2 per cent claimed that there were no facilities at all and the remaining 5 per cent alleged different acts of corruption, according to the 2011 report by the High Level Expert Group on Universal Health Coverage. A potential area of concern for the new wellness centres could be the reliance of rural patients on non-degree allopathic practitioners (NDAPs), or practitioners without an MBBS, according to a study carried out in Uttar Pradesh and Bihar. Studies in rural Karnataka, Andhra Pradesh and Odisha have shown reliance on private practitioners for multiple reasons. The biggest of these is the lack of easy access to public health facilities: 73 per cent sub-centres were more than 3 km from patients, 28 per cent sub-centres and 20 per cent PHCs were not accessible by public transport, concluded an IndiaSpend analysis of a Comptroller and Auditor General report. The easy availability and proximity of an NDAP allowed for faster consultation, according to this 2014 study carried out in north India. “Embedded in the community, the NDAPs have adapted their services to people’s needs, preferences and economic capabilities”, making them the preferred resource for “all-in-one” services, the study said. Poor living and working conditions, irregular drug supply, weak infrastructure, professional isolation and the burden of administrative work: These are some of the challenges faced by doctors on rural postings, stated a 2017 study by the Public Health Foundation of India. As of 2018, India has 497 medical colleges registered with the Medical Council of India (MCI) that together offer an intake capacity of 60,680 seats for MBBS. Trends in India, as well as other BRICS nations such as South Africa, suggest that most doctors prefer to sign up for hospital-based specialisations in urban areas than get into general practice at PHCs, a 2015 study published in Human Resources for Health observed. To address this, policy frameworks in several states have mandated compulsory rural service of 1-5 years during postgraduate medical studies. Further, some states require medical officers to practise medicine in rural areas for a particular period after postgraduate studies. Mid-level health providers could be the solution to the shortage of doctors in rural areas, according to this report of a national consultation on strengthening rural healthcare, 2018. “A key challenge that India faces is that even after diagnosis, people continue to use health care services in secondary and tertiary settings, for conditions which can be managed at the primary care level,” said Chandrakant Lahariya, the national professional officer, Universal Health Coverage, WHO. (This article was originally published on DNA. Read the original article) (Disclaimer: The opinions expressed above are the personal views of the author and do not reflect the views of ZMCL)

Ways to make Modicare work

BJP&#39;s &#39;Modicare&#39; came under renewed attack from the Congress leader and former finance minister P Chidambaram a day after the Union Budget. Taking to Twitter, Chidambaram referring to &#39;healthcare scheme&#39;, stated that a scheme without money is like flying a kite without a string. The kite flyer will say that the kite is flying, but there will be no kite and nothing will be flying.

&#39;&#39;Yesterday, I had said that the new HEALTH CARE SCHEME is a jumla with no money provided in the budget. Today, FM has admitted that no money has been provided and he will &#39;raise money in the future&#39;. Perfect jumla,&#39;&#39; he said in another Tweet.

<div class="ui-state-default" contenteditable="false">
<div class="twitter-block" draggable="false">
<blockquote class="twitter-tweet" data-lang="en">
Scheme without money is like flying a kite without a string. The kite flyer will say that the kite is flying, but there will be no kite 
and nothing will be flying.
&mdash; P. Chidambaram (@PChidambaram_IN) <a href="https://twitter.com/PChidambaram_IN/status/959340415454363654?ref_src=twsrc%5Etfw">February 2, 2018</a></blockquote>
<script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
<a class="close-mark close-div" href="#" id="jqclosemark">&times;</a></div>

Finance Minister Arun Jaitley in his budget speech announced a flagship national health insurance scheme that will cover about 50 crore people in India.&nbsp;

The health coverage of the scheme will be up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation. &ldquo;We are slowly progressing towards universal health coverage,&rdquo; Arun Jaitley said in his budget speech, adding that the scheme will be the &ldquo;world&rsquo;s largest healthcare programme,&rdquo; Jaitley added.

<div class="ui-state-default" contenteditable="false">
<div class="twitter-block" draggable="false">
<blockquote class="twitter-tweet" data-lang="en">
Yesterday, I had said that the new HEALTH CARE SCHEME is a jumla with no money provided in the budget. Today, FM has admitted that no money has been provided and he will &#39;raise money in the future&#39;. Perfect jumla.
&mdash; P. Chidambaram (@PChidambaram_IN) <a href="https://twitter.com/PChidambaram_IN/status/959340378120896513?ref_src=twsrc%5Etfw">February 2, 2018</a></blockquote>
<script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script></div>
<a class="close-mark close-div" href="#" id="jqclosemark">&times;</a></div>

The minister said out of the 25 crore families in India, the bottom 10 crore family which constitute 40 per cent of the population will benefit from the new healthcare plan.

&quot;The poor families will now have an insurance card and can go to any hospital and show their card to avail health benefits,&quot; he said.

&quot;We can make this scheme universal, then the world will have to acknowledge that whether Obamacare became successful or not, &#39;Modicare&#39; can definitely be made successful,&quot; the finance minister said.

On the question of funding of &quot;Modicare&quot;, the minister said it was mainly an operational detail and that it would be funded by the government.

&quot;The healthcare plan is a major step in ensuring the social security of the country,&quot; the minister said.

 
&nbsp;

Finance Minister Arun Jaitley in his budget speech announced a flagship national health insurance scheme that will cover about 50 crore people in India.

BJP's 'Modicare' came under renewed attack from the Congress leader and former finance minister P Chidambaram a day after the Union Budget. Taking to Twitter, Chidambaram referring to 'healthcare scheme', stated that a scheme without money is like flying a kite without a string. The kite flyer will say that the kite is flying, but there will be no kite and nothing will be flying. ''Yesterday, I had said that the new HEALTH CARE SCHEME is a jumla with no money provided in the budget. Today, FM has admitted that no money has been provided and he will 'raise money in the future'. Perfect jumla,'' he said in another Tweet. Scheme without money is like flying a kite without a string. The kite flyer will say that the kite is flying, but there will be no kite and nothing will be flying. — P. Chidambaram (@PChidambaram_IN) February 2, 2018 × Finance Minister Arun Jaitley in his budget speech announced a flagship national health insurance scheme that will cover about 50 crore people in India. The health coverage of the scheme will be up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation. “We are slowly progressing towards universal health coverage,” Arun Jaitley said in his budget speech, adding that the scheme will be the “world’s largest healthcare programme,” Jaitley added. Yesterday, I had said that the new HEALTH CARE SCHEME is a jumla with no money provided in the budget. Today, FM has admitted that no money has been provided and he will 'raise money in the future'. Perfect jumla. — P. Chidambaram (@PChidambaram_IN) February 2, 2018 × The minister said out of the 25 crore families in India, the bottom 10 crore family which constitute 40 per cent of the population will benefit from the new healthcare plan. "The poor families will now have an insurance card and can go to any hospital and show their card to avail health benefits," he said. "We can make this scheme universal, then the world will have to acknowledge that whether Obamacare became successful or not, 'Modicare' can definitely be made successful," the finance minister said. On the question of funding of "Modicare", the minister said it was mainly an operational detail and that it would be funded by the government. "The healthcare plan is a major step in ensuring the social security of the country," the minister said.

Scheme without money is like flying kite without string: Chidambaram mocks 'Modicare'

modicare

Modicare, News on Modicare, stories on Modicare, articles on Modicare, Modicare stories at Wion, Modicare news, Modicare latest news