Private Hospitals Find Modi’s Health Insurance Pricing Unviable
• Ridhima Saxena@Ridhima__Saxena
21 August 2018, 12:16 PM21 August 2018, 6:06 PM
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Calling the pricing unviable, private hospitals threatened to stay away from the Prime Minister’s health insurance scheme that will cover more than half-a-billion Indians.
The Indian Medical Association, a doctors’ lobby that agreed to bring small and medium hospitals on board, said the rates of medical procedures under the scheme were “unscientific, non-viable and will compromise on patient safety”, according to a June 22 letter to NITI Aayog. The prices calculated by the association were up to 84 percent higher than what the government fixed.
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Also Read: Most States Opt For Trusts Amid Rush To Roll Out Modi’s Health Insurance
“The existing package rates are at least 25 percent lower than even the break-even point for small and medium hospitals,” said Dr. RV Asokan, chairman at IMA Hospital Board of India that represents small hospitals. “If hospitals are to provide treatment at such unsustainable rates, they will end up shutting shop because of losses,” he said, adding that cost calculation needs to be transparent.
Participation of private hospitals is vital for the Pradhan Mantri Jan Arogya Yojana. That’s because half the households in the country, according to the National Family Health Survey published in July last year, don’t use state-run facilities because of poor access and quality. Moreover, India has one government doctor for every 11,082 people, according to the National Health Profile. That compares with the World Health Organization’s suggested ratio of 1:1,000.
Prime Minister Modi, in his Independence Day speech, announced the rollout from Sept. 25 to cover at least 10 crore families for Rs 5 lakh a year each. More than 8,800 hospitals have already expressed interest, according to Indu Bhushan, chief executive officer of the National Health Agency, the implementing authority. Nearly half of them, he said, are private.
Ravi Wankhedkar, national president of Indian Medical Association, countered that. They are purely expressions of interest, he said. “These are not conclusive and unless the issue of low package rates is resolved, no private hospital is likely to come on board.”
The association, which represents 33,000 hospitals across the country—including 15,000 small and medium—said a team should be constituted to fix costs of at least 150 common medical procedures. Low rates, according to IMA, would lead to poor quality of healthcare as hospitals would cut costs to break even.
Also Read: Beds In Rural Areas, Pricing Biggest Challenges To Ayushman Bharat Scheme
‘No Time’ To Study Costs
The IMA and the government, Wankhedkar said, had agreed that two representatives from the association will assist the Department of Health Research to form a consultative pricing group led by the NITI Aayog—which designed the scheme.
But no cost study was carried out. “We are really stretched in terms of rolling out the scheme and such a study can’t be done before the implementation begins,” Bhushan said. A comprehensive analysis of rates will be done in December-January, according to Bhushan, as it will take time to agree on a methodology, collect relevant data and discuss it.
The existing prices of 400 most-used medical packages fixed by NITI Aayog are based on Directorate General of Health Services’ analysis of insurance programmes offered by states, according to Bhushan. The pricing, he said, will vary with states, which have the freedom to revise them.
Yet, lack of a consultative approach has led to confusion and ambiguity, according to Girdhar Gyani, director general at Association of Healthcare Providers (India), which represents 40,700 large and about 8,000 small and medium hospitals. There is lack of clarity on claim settlement and even the rollout date, he said.
Also Read: 65 Lakh Families Identified For Modi’s Health Insurance Missing
‘Underfunded’
The government has allocated Rs 2,000 crore for 2018-19. “A scheme envisaging Rs 5 lakh coverage for 50 crore people should have at least Rs 1,16,000 crore allotted for adequate capitalisation. Only Rs 10,000-12,000 crore are expected to be the fund allotment,” IMA said in a dossier outlining its concerns. “Such gross underfunding will lead to a collapse of the scheme itself.”
India’s public expenditure on health is about 1 percent of its GDP, compared to the 1.4 percent spent by low-income countries and also below the global average of 5.9 percent, according to the World Health Organization’s Global Health Expenditure Database. The nation’s private sector contributes almost 74 per cent of this expenditure, according to a report by India Brand Equity Foundation citing RNCOS, Grant Thornton, LSI Financial Services and OECD. Without the participation of private hospitals, the prime minister’s scheme won’t be as effective.
“If the prime minister’s scheme has to run through public hospitals, which already provide free healthcare, what is the need of a universal insurance scheme in the first place?” Gyani asked. “I don’t think that any private hospital would formally sign up even by Sept. 25, the official launch date.”
Most States Opt For Trusts Amid Rush To Roll Out Modi’s Health Insurance
• Ridhima Saxena@Ridhima__Saxena
01 August 2018, 1:32 PM01 August 2018, 4:59 PM
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•
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•
Most states have opted to set up subsidy pools to fund Prime Minister Narendra Modi’s health insurance scheme that will cover more than half of Indians, as insurers stayed away because of pricing concerns and officials rush to meet the Aug. 15 deadline.
Twenty out of the 36 states and union territories will create non-profit trusts to pool in subsidy contributed by central and state governments, according to the National Health Agency, the implementing authority. Seven, including two union territories, opted for tying up with insurers—only one, Nagaland, has done so. Eight opted for the mixed model—payments below Rs 50,000 will be covered through insurance and the rest will be paid from the corpus.
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•
•
Odisha decided to stay out. Seven have still not officially joined but indicated preference for trusts, the agency said.
“It’s a quick fix,” said Anirudh Jain, who heads insurance at the financial services firm Centrum Group. Forming public-private partnerships with insurers takes time, and given the launch must happen on Independence Day, the trust model seems to be the only option left on the table, he said.
Indians pay over three-fourths of all healthcare costs out of pocket, according to a study by the Public Health Foundation of India published in May. Nearly 5.5 crore people were pushed below the poverty line because of healthcare expenses, of which 3.8 crore became poor only because they had to bear medicine costs, it said. Modi’s scheme targets such households. The Ayushman Bharat National Health Protection Mission will cover about 17 crore families a year through a cashless cover of Rs 5 lakh each.
It will subsume all existing plans in participating states, increasing the coverage from the initial 10 crore families. Only four—Andhra Pradesh, Telangana, Karnataka and Assam—followed the trust model.
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“It cannot be called insurance, which is more than just pooling of funds,” said Nidhesh Jain, financial services analyst at Investec Capital Services. The subsidy pools don’t involve price discovery through actuarial valuation, risk assessment, creation of reserves for expected claims or reinsurance, he said. “That could mean increased government liabilities, delay in claim settlement and more frauds in the long run.”
Joydeep Roy, insurance leader at PwC India, said the health insurance plan will yield better results if implemented in a public-private partnership. An insurer would ensure that claims management, technology, service delivery and fraud detection are robust to ensure profitability, he said.
The head of implementing authority, however, said states that opted for trusts “might have some distrust in insurance agencies” and felt that these pools can provide more effective service in a short period. Agreeing that the “government’s risk will be unlimited”, Indu Bhushan, chief executive officer of Ayushman Bharat, said in an emailed response that they were inspired by the good performance in Andhra Pradesh and Telangana.
The trust will get subsidy from a designated escrow account at Rs 500 for each family in the 60:40 ratio from the central and state governments. Bhushan said, “We will review the scheme after six months and based on the actual costs, the premium will be revised.”
Low Premium
An insurer that quotes the lowest premium is selected to join the scheme. The government pays it the premium to settle claims. Apollo Munich won the Nagaland bid at Rs 444 per family a year.
But for India’s largest general insurer, pricing is a concern. Ramesh Nag, chief manager (government health business) at state-run New India Assurance Company, cited the example of Rajasthan, where premium had to revised from Rs 370 to Rs 1,263 a family for a coverage of Rs 3 lakh a year.
“We are not making profits even at a higher premium as the claims ratio is over 200 percent,” he said. “How can we then quote anything less than Rs 2,500 a family for a scheme that has a sum assured of Rs 5 lakh?”
Jain of Investec Capital concurred. Calling the pricing “unsustainable”, he said insurers’ experience with the previous Rashtriya Swasthya Bima Yojana doesn’t inspire confidence. There were long delays in disbursal of premium subsidy while insurance companies had to pay the claims immediately, he said.
Moreover, the claims ratio of group health insurance—the closest in structure to the Prime Minister’s scheme— in general stays above 100 percent: that is insurers pay more to policyholders than they collect as premium.
Vinod Kumar Paul, member at NITI Aayog who was involved in planning the scheme, however, said there’s no pre-determined budget or premium, and the government will keep providing funds to trusts based on the claims received.
Hospitals Yet To Sign Up
Selecting hospitals to offer healthcare services hasn’t started yet. The implementing authority is initially looking to enrol 6,000—half of them state-run, Bhushan said. “We expect to have more than 10,000 hospitals enrolled by Aug. 15.”
Hospitals are, however, seeking better rates to provide quality services. Competitive package rates for hospitals would ensure better services and fewer frauds, according to Sanjay Datta, chief of underwriting and claims at ICICI Lombard General Insurance. “There is a high chance that private healthcare providers would stay away from the scheme if the present medical package rates are not made competitive. This could also lead to capacity constraints and substandard medical infrastructure—some of the issues companies faced in the initial stages of RSBY.”
Beds In Rural Areas, Pricing Biggest Challenges To Ayushman Bharat Scheme
• Tamanna Inamdar@TamannaInamdar
15 August 2018, 7:33 PM16 August 2018, 12:43 PM
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•
•
•
The biggest challenge to the Narendra Modi government’s ambitious plan to provide healthcare to 10 crore families will be the availability of hospital beds in tier-II and tier-III cities and in rural areas, said Indu Bhushan, chief executive officer of Ayushman Bharat.
The prime minister announced the roll-out of a pilot project on Sept. 25 under the scheme, also known as the National Health Protection Mission, during his Independence Day address on Wednesday. Ten states and union territories have been selected for the pilot run.
The scheme is essentially a Rs 5-lakh cashless family floater insurance covering all members of the household for a year. Bhushan, in an interview with BloombergQuint, said the private sector will be incentivised to open more hospitals “in lagging areas”. The pilot project, he said, will initially involve only government-run hospitals.
We are targeting 50 crore people. If, on average, 2 percent of them need hospitalization, we would have 1 crore admissions. And if we say that each hospital can provide 200 bed days we would need 2 lakh beds.
Indu Bhushan, CEO, Ayushman Bharat National Health Protection Mission
Bhushan admitted that a full roll-out—that will bring in approximately 50 crore Indians—in 40 days will be challenging. We have, from the hospitals that have come onboard, 60,000 beds, he said. He estimated that at least 2 lakh beds will be required if the scheme is to run at full capacity.
Pricing of health packages has been another pain-point, with the Indian Medical Association questioning the viability of providing healthcare at the proposed low costs. Bhushan said that this has been a “bone of contention” but assured that treatment rates under the scheme are “the median” and that states have the flexibility to change them.
We are hoping and expecting that we’ll find a middle ground. This is just the beginning and we’re putting a system in place for cost methodology.
Indu Bhushan, CEO, Ayushman Bharat National Health Protection Mission
BloombergQuint
65 Lakh Families Identified For Modi’s Health Insurance Missing
• Ridhima Saxena@Ridhima__Saxena
10 August 2018, 1:29 PM11 August 2018, 11:16 AM
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•
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•
Even before Prime Minister Narendra Modi’s health insurance scheme is rolled out for more than half a billion people, India found about 6 percent families missing during surveys conducted to curb the possibility of ghost beneficiaries.
The National Health Agency didn’t find 65 lakh of the 10.74 crore households that will be covered for Rs 5 lakh a year, Indu Bhushan, chief executive officer of the implementing authority, said in an emailed statement to BloombergQuint. The beneficiaries were selected based on the seven-year-old socioeconomic caste census.
The agency conducted field surveys across the country to verify families to be covered under the Ayushman Bharat National Health Protection Mission. Uttar Pradesh and Bihar contributed 70 percent of the missing families, Bhushan said. “Some families have either migrated to other cities or some of their members are no longer alive, causing a mismatch.”
India ranks 81 in Transparency International’s Corruption Perception Index of 180 nations. Pilferage of welfare benefits has been rampant. To counter that, Modi has pushed ahead with the Aadhaar biometric ID-based direct benefit transfers—rolled out towards the end of his predecessor Manmohan Singh's term—to plug subsidy leakage in everything from cooking gas to food security and rural jobs guarantee programmes.
Also Read: Most States Opt For Trusts Amid Rush To Roll Out Modi’s Health Insurance
For the health insurance scheme, identifying families during field surveys is the first step. The government is considering a stringent claim-settlement process for those who couldn’t be verified. These families will have to present government-authorised personal and family identification, Bhushan said. “Aadhaar details are preferred but other IDs will also be accepted for the first time.”
The scheme will eventually be bigger than originally planned as beneficiaries covered by states but not in the central scheme will also be included. That would take the total number of insured families to 17 crore.
The prime minister, who reviewed the progress ahead of the Independence Day announcement, sought a strong information technology system to reduce fraudulent claims, Bhushan said. There will also be other checks and balances, such as identification, limiting fraud-prone medical packages to public hospitals, medical audits and feedback, he said.
Maintaining Caution On ModiCare: ICICI Lombard
Ridhima Saxena @Ridhima__Saxena
22 June 2018, 6:46 AM22 June 2018, 6:46 AM
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Bidding for India’s health insurance scheme, dubbed Modicare, may’ve commenced, but ICICI Lombard General Insurance Ltd. prefers to wait and watch.
“We’ll have to see whether the pricing and the bidding that is happening is sustainable for a longer period of time,” said Bhargav Dasgupta, the company’s chief executive officer and managing director, told BloombergQuint on the sidelines of the launch of India’s first ‘Wellness Index’. “We’ll take a call on participating later.”
Based on experience from other schemes in the past, we’ve realised there is a lack of data, understanding and inefficient pricing in the initial period of implementation, Dasgupta told BloombergQuint. “In some such schemes the pricing becomes completely unviable from the insurer’s perspective and when that happens on a sustained basis, the schemes fail.”
The company has so far not taken part in the bidding process for the Prime Minister Rashtriya Swasthya Suraksha Mission (PMRSSM), dubbed Modicare.
• Ridhima Saxena@Ridhima__Saxena
21 August 2018, 12:16 PM21 August 2018, 6:06 PM
•
•
•
•
Calling the pricing unviable, private hospitals threatened to stay away from the Prime Minister’s health insurance scheme that will cover more than half-a-billion Indians.
The Indian Medical Association, a doctors’ lobby that agreed to bring small and medium hospitals on board, said the rates of medical procedures under the scheme were “unscientific, non-viable and will compromise on patient safety”, according to a June 22 letter to NITI Aayog. The prices calculated by the association were up to 84 percent higher than what the government fixed.
•
•
•
Also Read: Most States Opt For Trusts Amid Rush To Roll Out Modi’s Health Insurance
“The existing package rates are at least 25 percent lower than even the break-even point for small and medium hospitals,” said Dr. RV Asokan, chairman at IMA Hospital Board of India that represents small hospitals. “If hospitals are to provide treatment at such unsustainable rates, they will end up shutting shop because of losses,” he said, adding that cost calculation needs to be transparent.
Participation of private hospitals is vital for the Pradhan Mantri Jan Arogya Yojana. That’s because half the households in the country, according to the National Family Health Survey published in July last year, don’t use state-run facilities because of poor access and quality. Moreover, India has one government doctor for every 11,082 people, according to the National Health Profile. That compares with the World Health Organization’s suggested ratio of 1:1,000.
Prime Minister Modi, in his Independence Day speech, announced the rollout from Sept. 25 to cover at least 10 crore families for Rs 5 lakh a year each. More than 8,800 hospitals have already expressed interest, according to Indu Bhushan, chief executive officer of the National Health Agency, the implementing authority. Nearly half of them, he said, are private.
Ravi Wankhedkar, national president of Indian Medical Association, countered that. They are purely expressions of interest, he said. “These are not conclusive and unless the issue of low package rates is resolved, no private hospital is likely to come on board.”
The association, which represents 33,000 hospitals across the country—including 15,000 small and medium—said a team should be constituted to fix costs of at least 150 common medical procedures. Low rates, according to IMA, would lead to poor quality of healthcare as hospitals would cut costs to break even.
Also Read: Beds In Rural Areas, Pricing Biggest Challenges To Ayushman Bharat Scheme
‘No Time’ To Study Costs
The IMA and the government, Wankhedkar said, had agreed that two representatives from the association will assist the Department of Health Research to form a consultative pricing group led by the NITI Aayog—which designed the scheme.
But no cost study was carried out. “We are really stretched in terms of rolling out the scheme and such a study can’t be done before the implementation begins,” Bhushan said. A comprehensive analysis of rates will be done in December-January, according to Bhushan, as it will take time to agree on a methodology, collect relevant data and discuss it.
The existing prices of 400 most-used medical packages fixed by NITI Aayog are based on Directorate General of Health Services’ analysis of insurance programmes offered by states, according to Bhushan. The pricing, he said, will vary with states, which have the freedom to revise them.
Yet, lack of a consultative approach has led to confusion and ambiguity, according to Girdhar Gyani, director general at Association of Healthcare Providers (India), which represents 40,700 large and about 8,000 small and medium hospitals. There is lack of clarity on claim settlement and even the rollout date, he said.
Also Read: 65 Lakh Families Identified For Modi’s Health Insurance Missing
‘Underfunded’
The government has allocated Rs 2,000 crore for 2018-19. “A scheme envisaging Rs 5 lakh coverage for 50 crore people should have at least Rs 1,16,000 crore allotted for adequate capitalisation. Only Rs 10,000-12,000 crore are expected to be the fund allotment,” IMA said in a dossier outlining its concerns. “Such gross underfunding will lead to a collapse of the scheme itself.”
India’s public expenditure on health is about 1 percent of its GDP, compared to the 1.4 percent spent by low-income countries and also below the global average of 5.9 percent, according to the World Health Organization’s Global Health Expenditure Database. The nation’s private sector contributes almost 74 per cent of this expenditure, according to a report by India Brand Equity Foundation citing RNCOS, Grant Thornton, LSI Financial Services and OECD. Without the participation of private hospitals, the prime minister’s scheme won’t be as effective.
“If the prime minister’s scheme has to run through public hospitals, which already provide free healthcare, what is the need of a universal insurance scheme in the first place?” Gyani asked. “I don’t think that any private hospital would formally sign up even by Sept. 25, the official launch date.”
Most States Opt For Trusts Amid Rush To Roll Out Modi’s Health Insurance
• Ridhima Saxena@Ridhima__Saxena
01 August 2018, 1:32 PM01 August 2018, 4:59 PM
•
•
•
•
Most states have opted to set up subsidy pools to fund Prime Minister Narendra Modi’s health insurance scheme that will cover more than half of Indians, as insurers stayed away because of pricing concerns and officials rush to meet the Aug. 15 deadline.
Twenty out of the 36 states and union territories will create non-profit trusts to pool in subsidy contributed by central and state governments, according to the National Health Agency, the implementing authority. Seven, including two union territories, opted for tying up with insurers—only one, Nagaland, has done so. Eight opted for the mixed model—payments below Rs 50,000 will be covered through insurance and the rest will be paid from the corpus.
•
•
•
Odisha decided to stay out. Seven have still not officially joined but indicated preference for trusts, the agency said.
“It’s a quick fix,” said Anirudh Jain, who heads insurance at the financial services firm Centrum Group. Forming public-private partnerships with insurers takes time, and given the launch must happen on Independence Day, the trust model seems to be the only option left on the table, he said.
Indians pay over three-fourths of all healthcare costs out of pocket, according to a study by the Public Health Foundation of India published in May. Nearly 5.5 crore people were pushed below the poverty line because of healthcare expenses, of which 3.8 crore became poor only because they had to bear medicine costs, it said. Modi’s scheme targets such households. The Ayushman Bharat National Health Protection Mission will cover about 17 crore families a year through a cashless cover of Rs 5 lakh each.
It will subsume all existing plans in participating states, increasing the coverage from the initial 10 crore families. Only four—Andhra Pradesh, Telangana, Karnataka and Assam—followed the trust model.
•
•
•
“It cannot be called insurance, which is more than just pooling of funds,” said Nidhesh Jain, financial services analyst at Investec Capital Services. The subsidy pools don’t involve price discovery through actuarial valuation, risk assessment, creation of reserves for expected claims or reinsurance, he said. “That could mean increased government liabilities, delay in claim settlement and more frauds in the long run.”
Joydeep Roy, insurance leader at PwC India, said the health insurance plan will yield better results if implemented in a public-private partnership. An insurer would ensure that claims management, technology, service delivery and fraud detection are robust to ensure profitability, he said.
The head of implementing authority, however, said states that opted for trusts “might have some distrust in insurance agencies” and felt that these pools can provide more effective service in a short period. Agreeing that the “government’s risk will be unlimited”, Indu Bhushan, chief executive officer of Ayushman Bharat, said in an emailed response that they were inspired by the good performance in Andhra Pradesh and Telangana.
The trust will get subsidy from a designated escrow account at Rs 500 for each family in the 60:40 ratio from the central and state governments. Bhushan said, “We will review the scheme after six months and based on the actual costs, the premium will be revised.”
Low Premium
An insurer that quotes the lowest premium is selected to join the scheme. The government pays it the premium to settle claims. Apollo Munich won the Nagaland bid at Rs 444 per family a year.
But for India’s largest general insurer, pricing is a concern. Ramesh Nag, chief manager (government health business) at state-run New India Assurance Company, cited the example of Rajasthan, where premium had to revised from Rs 370 to Rs 1,263 a family for a coverage of Rs 3 lakh a year.
“We are not making profits even at a higher premium as the claims ratio is over 200 percent,” he said. “How can we then quote anything less than Rs 2,500 a family for a scheme that has a sum assured of Rs 5 lakh?”
Jain of Investec Capital concurred. Calling the pricing “unsustainable”, he said insurers’ experience with the previous Rashtriya Swasthya Bima Yojana doesn’t inspire confidence. There were long delays in disbursal of premium subsidy while insurance companies had to pay the claims immediately, he said.
Moreover, the claims ratio of group health insurance—the closest in structure to the Prime Minister’s scheme— in general stays above 100 percent: that is insurers pay more to policyholders than they collect as premium.
Vinod Kumar Paul, member at NITI Aayog who was involved in planning the scheme, however, said there’s no pre-determined budget or premium, and the government will keep providing funds to trusts based on the claims received.
Hospitals Yet To Sign Up
Selecting hospitals to offer healthcare services hasn’t started yet. The implementing authority is initially looking to enrol 6,000—half of them state-run, Bhushan said. “We expect to have more than 10,000 hospitals enrolled by Aug. 15.”
Hospitals are, however, seeking better rates to provide quality services. Competitive package rates for hospitals would ensure better services and fewer frauds, according to Sanjay Datta, chief of underwriting and claims at ICICI Lombard General Insurance. “There is a high chance that private healthcare providers would stay away from the scheme if the present medical package rates are not made competitive. This could also lead to capacity constraints and substandard medical infrastructure—some of the issues companies faced in the initial stages of RSBY.”
Beds In Rural Areas, Pricing Biggest Challenges To Ayushman Bharat Scheme
• Tamanna Inamdar@TamannaInamdar
15 August 2018, 7:33 PM16 August 2018, 12:43 PM
•
•
•
•
The biggest challenge to the Narendra Modi government’s ambitious plan to provide healthcare to 10 crore families will be the availability of hospital beds in tier-II and tier-III cities and in rural areas, said Indu Bhushan, chief executive officer of Ayushman Bharat.
The prime minister announced the roll-out of a pilot project on Sept. 25 under the scheme, also known as the National Health Protection Mission, during his Independence Day address on Wednesday. Ten states and union territories have been selected for the pilot run.
The scheme is essentially a Rs 5-lakh cashless family floater insurance covering all members of the household for a year. Bhushan, in an interview with BloombergQuint, said the private sector will be incentivised to open more hospitals “in lagging areas”. The pilot project, he said, will initially involve only government-run hospitals.
We are targeting 50 crore people. If, on average, 2 percent of them need hospitalization, we would have 1 crore admissions. And if we say that each hospital can provide 200 bed days we would need 2 lakh beds.
Indu Bhushan, CEO, Ayushman Bharat National Health Protection Mission
Bhushan admitted that a full roll-out—that will bring in approximately 50 crore Indians—in 40 days will be challenging. We have, from the hospitals that have come onboard, 60,000 beds, he said. He estimated that at least 2 lakh beds will be required if the scheme is to run at full capacity.
Pricing of health packages has been another pain-point, with the Indian Medical Association questioning the viability of providing healthcare at the proposed low costs. Bhushan said that this has been a “bone of contention” but assured that treatment rates under the scheme are “the median” and that states have the flexibility to change them.
We are hoping and expecting that we’ll find a middle ground. This is just the beginning and we’re putting a system in place for cost methodology.
Indu Bhushan, CEO, Ayushman Bharat National Health Protection Mission
BloombergQuint
65 Lakh Families Identified For Modi’s Health Insurance Missing
• Ridhima Saxena@Ridhima__Saxena
10 August 2018, 1:29 PM11 August 2018, 11:16 AM
•
•
•
•
Even before Prime Minister Narendra Modi’s health insurance scheme is rolled out for more than half a billion people, India found about 6 percent families missing during surveys conducted to curb the possibility of ghost beneficiaries.
The National Health Agency didn’t find 65 lakh of the 10.74 crore households that will be covered for Rs 5 lakh a year, Indu Bhushan, chief executive officer of the implementing authority, said in an emailed statement to BloombergQuint. The beneficiaries were selected based on the seven-year-old socioeconomic caste census.
The agency conducted field surveys across the country to verify families to be covered under the Ayushman Bharat National Health Protection Mission. Uttar Pradesh and Bihar contributed 70 percent of the missing families, Bhushan said. “Some families have either migrated to other cities or some of their members are no longer alive, causing a mismatch.”
India ranks 81 in Transparency International’s Corruption Perception Index of 180 nations. Pilferage of welfare benefits has been rampant. To counter that, Modi has pushed ahead with the Aadhaar biometric ID-based direct benefit transfers—rolled out towards the end of his predecessor Manmohan Singh's term—to plug subsidy leakage in everything from cooking gas to food security and rural jobs guarantee programmes.
Also Read: Most States Opt For Trusts Amid Rush To Roll Out Modi’s Health Insurance
For the health insurance scheme, identifying families during field surveys is the first step. The government is considering a stringent claim-settlement process for those who couldn’t be verified. These families will have to present government-authorised personal and family identification, Bhushan said. “Aadhaar details are preferred but other IDs will also be accepted for the first time.”
The scheme will eventually be bigger than originally planned as beneficiaries covered by states but not in the central scheme will also be included. That would take the total number of insured families to 17 crore.
The prime minister, who reviewed the progress ahead of the Independence Day announcement, sought a strong information technology system to reduce fraudulent claims, Bhushan said. There will also be other checks and balances, such as identification, limiting fraud-prone medical packages to public hospitals, medical audits and feedback, he said.
Maintaining Caution On ModiCare: ICICI Lombard
Ridhima Saxena @Ridhima__Saxena
22 June 2018, 6:46 AM22 June 2018, 6:46 AM
FOLLOW US
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•
•
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•
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Editor's Choice
• I “Challenge” My Critic To Criticise Me; Welcome To Post-Truth India
• Will Kotak’s Route To Bring Down Promoter Holding Pass Muster With RBI?
• Monetary Policy: Having Hiked Rates As Expected, MPC Now Set For A Pause
• India’s Payments Banks Trip On E-KYC Rules
• How HDFC May Have Spared Itself Further Blushes
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Bidding for India’s health insurance scheme, dubbed Modicare, may’ve commenced, but ICICI Lombard General Insurance Ltd. prefers to wait and watch.
“We’ll have to see whether the pricing and the bidding that is happening is sustainable for a longer period of time,” said Bhargav Dasgupta, the company’s chief executive officer and managing director, told BloombergQuint on the sidelines of the launch of India’s first ‘Wellness Index’. “We’ll take a call on participating later.”
Based on experience from other schemes in the past, we’ve realised there is a lack of data, understanding and inefficient pricing in the initial period of implementation, Dasgupta told BloombergQuint. “In some such schemes the pricing becomes completely unviable from the insurer’s perspective and when that happens on a sustained basis, the schemes fail.”
The company has so far not taken part in the bidding process for the Prime Minister Rashtriya Swasthya Suraksha Mission (PMRSSM), dubbed Modicare.
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