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As a scheme, the Ayushman Bharat National Health Protection Mission, informally dubbed “Modicare”, appears to be an excellent cashless mediclaim. As a portable family floater policy, it is without any restrictions, and covers almost all secondary care and most of tertiary care procedures. It promises to cover pre-existing diseases right from day one and is a dream come true, especially for the elderly shunned by insurance companies. Besides, it will fully cover both pre and post-hospitalisation expenses. More importantly, the scheme, theoretically, allows the poor to access world-class healthcare facilities of empanelled private hospitals, hitherto a privilege of the rich, or the insured.
However, some practical issues remain to be addressed. Experience tells us that as in the case of many Centrally-sponsored schemes, states will be entrusted to implement the ambitious plan adding its share of matching grants, within a defined time frame. The scheme envisages the Centre bearing 60 per cent of the commitment while the States will have to underwrite the rest. Considering that the health of most state governments is precarious, it will add onerous burden on the states to raise funds to meet its share of 40 per cent.
The success of “Modicare” also depends on a robust infrastructure and efficient institutional mechanism. At present, both are missing from the Indian public healthcare system. It would be a challenge for the government to coax expensive private hospitals to get empanelled under “Modicare”, abandoning their USP that is exclusivity. Although the poor are expected to be identified from the Socio Economic and Caste Census (SECC) database, doubts have been raised about its accuracy. Besides, the number of poor families is far in excess of 10.74 crore. What would happen to the healthcare of those left out of the scheme? For want of inadequate attention to the fine print, “Modicare” could well turn out to be another “Obamacare”, a noble plan that floundered because of a faulty funding mechanism.
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