ayushman bharat – Health and Wellness Centre

By Admin in Health Insurance in India

Sep 27

Health and Wellness Centre has become one of the largest sectors in India in terms of revenue and employment. A booming population, rising income levels, growth in infrastructure, increased awareness, insurance policies and India’s emergence as a hub of medical tourism and clinical trials have contributed to the development of healthcare sector in India. As the needs of this sector are increasing, to provide up to date medical facilities is very essential. Government-funded health insurance would enable poor in India to get benefited from timely care without the burden of out of pocket expenditure. The country’s average out-of-pocket expenditure on healthcare is one of the highest globally, at 68%, and this means that of every Rs 100 spent by the public on health care, Rs 68 comes from their pocket (the rest is reimbursed by insurance or is provided by the government).

In comparison, the out-of-pocket expenditure is much lower in China, at 34%, and in the US it is 11%. Due to this high out-of-pocket healthcare expenditure, 7% of the population in India is pushed below poverty threshold every year.

To address this the Government started two major initiatives in the health insurance sector, as part of Ayushman Bharat programme. They are Health and Wellness Centre and National Health Protection Scheme. this was aimed at making path-breaking interventions to address health holistically, in the primary, secondary and tertiary care systems, covering both prevention and health promotion. This takes India towards the goal of universal health coverage and building Swasth Bharat. The bottom 40% of the population can now access healthcare at secondary and tertiary level institutions belonging to the public health system and private health system.

 

Health and Wellness Centre

The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centers will bring health care system closer to the homes of people. These Health and Wellness Centre will provide a comprehensive Health and Wellness Centre, including for non-communicable diseases and maternal and child health services. These centers will also provide free essential drugs and diagnostic services.

National Health Protection Scheme

National Health Protection Scheme will cover over 10 crore poor and vulnerable families(approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization.

 

The scheme would create tremendous awareness of health insurance, the same way Jan Dhan did for bank accounts. People in countries that provided higher health insurance cover had a higher life expectancy. The same will happen in India now with this scheme if it is implemented properly. Access to tertiary healthcare in India currently faces a huge challenge, both in terms of infrastructure and qualified medical professionals, especially in rural areas. The move to open one medical college for every three parliamentary constituencies will help in addressing the challenge related to an availability of healthcare professionals in hospitals, improve access to Health and Wellness Centre bridge the demand-supply gap.

ELIGIBILITY:

Every person listed in the Socio-Economic Caste Census (SECC) database will automatically be enrolled in the scheme. While the beneficiaries can avail benefits in both public and impaneled private facilities, the payment for treatment will be done on the package rate (to be defined by the government in advance) basis.

People who are eligible to receive the benefits of the Health and Wellness Centre under the Ayushman Bharat scheme are as follows:

In Rural areas:

  1. Households living in only one room with Kucha walls and Kucha roof.
  2. Households with no adult member between age 16 to 59
  3. Female-headed households with no adult male member between age 16 to 59
  4. Households having at least one disabled member and no able-bodied adult member
  5. SC/ST households
  6. Landless households deriving a major part of their income from manual casual labor
  7. Households without shelter
  8. Destitute/ living on alms
  9. Manual scavenger families
  10. Primitive tribal groups
  11. Legally released bonded labor

In Urban areas:

The following occupational category of workers are automatically included in the list

  1. Ragpicker
  2. Beggar
  3. Domestic worker
  4. Street vendor/ Cobbler/hawker / Other service provider working on streets
  5. Construction worker/ Plumber/ Mason/ Labour/ Painter/ Welder/ Security guard/ Coolie and another head-load worker
  6. Sweeper/ Sanitation worker / Mali
  7. Home-based worker/ Artisan/ Handicrafts worker / Tailor
  8. Transport worker/ Driver/ Conductor/ Helper to drivers and conductors/ Cart puller/ Rickshaw puller
  9. Shop worker/ Assistant/ Peon in small establishment/ Helper/Delivery assistant / Attendant/ Waiter
  10. Electrician/ Mechanic/ Assembler/ Repair worker
  11. Washer-man/ Chowkidar

 

NHPS scheme involves private hospitals and insurers as the major stakeholders. It is important to address the concerns of misuse by private hospitals.

This calls for a well-defined list of conditions that will be covered, adoption of standard clinical guidelines for diagnostic tests and treatments suitable for different disorders, setting and monitoring of cost and quality standards, and measuring health outcomes and cost-effectiveness.

Both Central and Health and Wellness Centre will have to develop the capacity for competent purchasing of services from a diverse group of providers to avoid hospitals to undertake unnecessary tests and treatments to tap the generous coverage. Primary health services will reduce the need for advanced care. Hence along with providing insurance coverage, there is also a need for proactively strengthening primary health services and public hospitals.      An ombudsman to deal with complaints from NHPM users should, therefore, be a priority. The Centre should extend the scheme to all children and senior citizens, and cover out-patient consultation and essential drugs to sharply reduce out-of-pocket spending.

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