Issues Of Detail In National Health Protection Scheme, NHPS
The announcement of the “world’s largest health protection plan” was followed by questions over whether the healthcare system had the capacity to handle a scheme of such proportions, and whether the NHPS wouldn’t end up being an unbearable burden on the exchequer.
Health Ministry and NITI Aayog are now studying the experience of states such as Kerala, Tamil Nadu, Andhra Pradesh and Telangana, where similar schemes are already in force. During the consultation organised by the Ministry last month, the states flagged several challenges.
In health insurance parlance, “moral hazard” is the tendency of insured people to buy or be sold additional healthcare interventions irrespective of their actual needs, leading to expenses that do not necessarily add to their well-being, but which bleed the insurer.
Typical moral hazard procedures include Caesarean sections, hysterectomies, and procedures for inserting orthopaedic implants.
All non-emergency surgical and medical packages now require pre-authorisation in Kerala. These include cardiovascular, cardiothoracic, and neurosurgical procedures. Tamil Nadu has listed 138 procedures under the Chief Minister’s Comprehensive Health Insurance Scheme. But these procedures, including arthroplasty and pancreatectomy, are covered only if they are carried out in government hospitals.
Union Health Secretary recently informed states that eligibility for NHPS will be determined based on data from the socio-economic caste census (SECC). The proposed target population is (a) families that belong to any of the 7 deprivation criteria (b) automatically included families as per SECC database for rural areas and (c) defined occupational criteria for urban areas.
But several states argued that depending on the SECC would limit the reach of the scheme. Maharashtra, for example, currently provides a Rs 2 lakh annual health cover to about one crore people, this would fall to 60 lakh people if the state were to follow SECC data. The other issue is of the identification document.
Deciding what procedures would be included in the NHPS list is one of the most crucial decisions. During initial meetings with general insurers, NITI Aayog had calculated the annual premium per family to be Rs 1,082.
However, insurers have pegged the actuarial premium at Rs 2,500, citing the sustainability of the scheme. If the government agrees to the premium amount put forth by the insurers, the cost will more than double from the present estimate of Rs 10,000 crore.
Directorate General of Health Services (DGHS) has been asked to prepare a list of procedures/diseases to be covered under NHPS. Once finalised, the list will be circulated to states who opt for the scheme, with a provision to make marginal changes in the package rates.
Source Link- http://indianexpress.com/.