OIt is extremely worrying that nearly 60 million Indians are pushed into poverty because they are,  unfortunately, compelled to shell out half of their annual household expenditure to meet medical needs, especially when it comes to hospitalisation. Even after 70 years of independence, there is no real health insurance scheme for 80 per cent of the Indian population.

One of the major healthcare scheme, ‘Ayushman Bharat’, announced by the Union Government in this  Budget, is as a game-changer. It aims to ensure better healthcare to the people, particularly from the lower strata of the society. The scheme has two components — the Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM) and health and wellness centres. The PMRSSM, a  mega healthcare scheme, aims to provide free health treatment up to five lakh rupees to the poor and vulnerable sections of the society. More than 10 crore identified families, covering more than 50 crore, are entitled to benefit under this mission. 

For a focused approach and better implementation of the scheme, a dedicated society, called the National Health Agency (NHA), has been formed to administer and implement the PMRSSM under the Ministry of Health & Family Welfare.

As a first step, to roll out the PMRSSM, several Memorandum of Understandings (MoUs) have been  signed between four States — Himachal Pradesh, Haryana, Jammu & Kashmir, Uttarakhand and Union Territory of Chandigarh with the National Health Agency. Rest of the States are expected to follow suit soon.

PMRSSM is expected to provide cashless and paperless access to services for the beneficiary at both public and private empanelled hospitals across the country.  There will be no capping on family size. This will ensure that all members of designated families, specifically girl child and senior citizens, get maximum coverage.

Besides, preference is also being accorded to make woman as the head of the family to ensure gender justice. More than 1,300 medical packages have been defined, that covers surgery, medical and day care treatments, including medicines, diagnostics,  among others.

The PMRSSM is designed on entitlement basis. This means every family figuring in defined Socio Economic Caste Census (SECC), 2011 database will be entitled to claim benefit under the scheme. States will have an option to use an existing trust/society/not-for-profit organistaion or set up a new trust/society/NGO.

States will also be at liberty to  choose the modalities for implementation. They can implement scheme through insurance company or directly through the trust/society or a mixed model.

Notably, a well-defined complaint and public grievance redressal mechanism will be instituted, actively utilising electronic, mobile platform, Internet as well as social media and robust safeguards to prevent misuse, fraud or abuse by providers and users. Pre-authorisation will be made mandatory for all tertiary care and selected secondary care packages.

Almost 1.50 lakh primary healthcare centres across the country will be upgraded and well-equipped with diagnostics, drugs and doctors laying the foundation of India’s new healthcare system. These centres aim for early detection of diseases. Universal health checkup will be ensured of every individual before they attain 30 years of age.

The Government enlists cooperation of State Governments in the true spirit of cooperative federalism, insurance companies, hospitals and diagnostic centres, pharma companies, health fund managers and the corporates. This will transform Indian health sector in a significant manner as it will make healthcare easily accessible and effective to the poorest of the poor.  It is the need of the hour.