PRESENTED BY:

AKANKSHA KADAM
ANIKET DESAI
KAJOL VALECHA
NOOPUR GAIKWAD
SHRUTIKA THETE
SHIPRA SATI
 National Health
Protection Mission
(NHPM)
Health Assurance for New India @ 2022

2
 HEALTH CARE IN INDIA
• Healthcare in India is largely unpenetrated, with
government expenditure just above 1% of the GDP and
an underperforming public healthcare ecosystem.

• It is extremely worrying that nearly 55–60 million

Indians are pushed into poverty every year because they
are unfortunately compelled to shell out half of their
annual household expenditure to meet medical needs,
especially for hospitalization.

• Even after 70 years of independence, there is no real

health insurance scheme for 80% of the Indian
population.
Graphical representation
 Comparing India with other Countries.
• Vast difference in spends as % of GDP
In India the total expenditure on healthcare as percentage of GDP
is just above 1%, while in the US it is 17%.

• Out of the pocket expenditure

70% of the Indian population pays out of their own pocket for
medical expenditures.. In the US, the out of the pocket
expenditure is much lower at 10-12%.

• Health insurance is mandatory in the other countries, unlike

India:It's mandatory to get health insurance and you have to pay
a penalty if for some reason you choose not to get it.
Graphical representation of
physicians per thousand population
 Ayushman Bharat

Rashtriya Swasthya Beema

Yojana

Senior Citizen Health

Insurance Scheme
AYUSHMAN BHARAT SCHEME
HEALTH INSURANCE IN INDIA
Features of National Health Protection Scheme (NHPS)
• Ayushman Bharat – It will have a defined benefit cover of Rs. 5 lakh per family per
year.
• Cashless benefits from any public/private empanelled hospitals across the country.
• Entitlement based scheme with entitlement decided on the basis of deprivation
criteria in the SECC database.
• Core principles:Co-operative federalism and flexibility to states.
• For giving policy directions and fostering coordination between Centre and States,
it is proposed to set up Ayushman Bharat National Health Protection Mission
Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare
Minister.
• States would need to have State Health Agency (SHA) to implement the scheme.
• To ensure that the funds reach SHA on time, the transfer of funds from Central
Government through Ayushman Bharat - National Health Protection Mission to
State Health Agencies may be done through an escrow account directly.
• Robust IT framework in partnership with NITI Aayog.
10
 Current Status – State Schemes
Approx
Name of the Type of Conditions
Cover provided Population
State covered
Covered
Andhra Mostly tertiary and
Pradesh Rs. 2.5 lakh very few secondary 80% of the State
Mostly tertiary and
Tamil Nadu Rs. 1.5 lakh very few secondary 60% of the State
Rs. 1.5 lakh + Rs. 2.5
lakh for Kidney Mostly tertiary and
Maharashtra transplant very few secondary 60% of the State
Secondary till 30,000
Rajasthan Rs. 30,000 + Rs. 3 lakh and tertiary for 3 lakh50% of the State
Secondary till 30,000
Himachal Rs. 30,000 + Rs. 1.75 and tertiary for 1.75
Pradesh lakh lakh 50% of the State
Secondary till 30,000
Gujarat Rs. 30,000 + Rs. 2 lakh and tertiary for 2 lakh40% of the State

States implementing schemes with cover from Rs. 30,000 to

11
Rs. 3 lakh
Ministry and council under Ayush
Co-operative Federation

Regulator –
Financed by –
Union Health
Finance Ministry
Ministry

Agency -
Council –
Ayushman
Ayushman
Bharat National
Bharat National
Health
Health
Protection
Protection
Agency (State
Mission Council
Health Agency)
Major impact of Ayushman Bharat
• Increased benefit cover to nearly 40% of the population,
(the poorest & the vulnerable)
• Covering almost all secondary and many tertiary
hospitalizations. (except a negative list)
• It will cover over 10 crore poor and vulnerable families and
approximately 50 crore families.
• This will lead to increased access to quality health and
medication. In addition, the unmet needs of the population
which remained hidden due to lack of financial resources
will be catered to.
 IMPACT OF AYUSHMAN BHARAT SCHEME
ON CURRENT HEALTHCARE SYSTEM
PHARMACEUTICALS DIGITAL AND IT
HOSPITALS AND DIAGNOSTICS INSURANCE SERVICE PROVIDER GOVERNMENT

• Push for • Focus on low- • To build • Develop IT • Identify

package rates cost good capacities for architecture additional
quality drugs effective to link patient sources of
• Focus on and on claims data, hospital financing
quality centralized management, data and
procurement actuarial insurance • Build in
• Focus on capacities, companies system
accreditation • Focus on clinical audit with Socio- automation
supply side capacity and Economic for monitoring
• Focus on shortages hospital Caste Census and grievance
operational scrutiny (SECC) and redressal
improvements Aadhaar data
to reduce costs • Negotiate • Regulators to
package rates, • Digitization ensure fair
improve trends will competition
system further help in
automation reduction of
costs, etc.
Challenges of Ayushman Bharat Scheme

Shortage of doctors (1:1900)

Access to Remote citizens

Robust medical infrastructure

Proper Co-ordination
(Govt. – Insurance agency - Hospital – Citizen)
Rashtriya Swathya Beema Yojana

RSBY was launched in early 2008 and was initially designed to

target only the Below Poverty Line (BPL) households, but has
been expanded to cover other defined categories of
unorganised workers, covering:

1. Building and other construction workers registered with the

Welfare Boards
2. Licensed Railway Porters
3. Street Vendors
4. MNREGA workers who have worked for more than 15 days
during the preceding financial year
5. Beedi Workers
6. Domestic Workers
7. Sanitation Workers
8. Mine Workers
9. Rickshaw pullers
10. Rag pickers
11. Auto/Taxi Driver
 The premium cost for enrolled beneficiaries under the scheme is shared by
Government of India and the State Governments.

The program has the target to cover 70 million households by the end of the
Twelfth Five Year Plan (2012-17). Its main service delivery model remained as
demand financing, freedom of choice among accredited government and private
hospitals, and cashless service reimbursable to provider on a pre-determined
package rates on family floater basis, could become a strong pillar for the
universal health care system laid down by Government of India
Since 1st April, 2015, the Scheme Rashtriya Swasthya Bima Yojana (RSBY) has been
transferred to Ministry of Health & Family Welfare on “as is where is” basis.
Ministry of Health & Family Welfare is administering and implementing the
scheme through a decentralized implementation structure at the State level.
Objective of RSBY:-
1.To provide financial protection against catastrophic health costs by reducing out

2.To improve access to quality health care for below poverty line households of pocket
expenditure for hospitalization and other vulnerable groups in the unorganized sector
Senior Citizen Health Insurance Scheme
(SCHIS)
Features of SCHIS:
• Benefit is available to senior citizen (above 60 years).
• The candidate should be Rashtriya Swasthya Bima Yojna
(RSBY) smart card holder.
• The beneficiary has to pay only a nominal annual
premium for SCHIS which is up to Rs. 500 per family.
• Moreover, Central and State government will share the
insurance premium in the ratio of 90:10 under the Trust
Model.
• No separate enrolment process, beneficiary will be
selected only among the smart card holders of RSBY.
• All the financial transactions between government and
insurance company will be done through bank channel.
Modicare Vs Obamacare
• targeting the poor in
India
• more than 10 Crore
vulnerable families 5 lakh
per family
• capped at Rs 5 Lakhs per
family per year.
• covers a much larger
population
• No'Individual Mandate
• targets the middle-class
also
• compulsory for every
citizen in the US and
subsidies for those who
can not afford it
• no such limits
• Lesser than Modicare
• controversial
plan(Government raised
money by penalizing
citizens who did not have
health insurance)
How to check Eligibility – Ayushman Bharat Yojana
Website –
https://mera.pmjay.gov.in/search/login

Helpline No. – 14555

Aarogya Mitra Helpdesk