Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources
From UPSC perspective, the following things are important:
Prelims level: Ayushman Bharat scheme, Rashtriya Swasthya Bima Yojana, Senior Citizen Health Insurance Scheme, SECC
Mains level: Universal health coverage and related issues
Status of States Joining the ambitious programme
- Twenty States are on board to implement the Ayushman Bharat Scheme by having a MoU with the Union Ministry of Health and Family Welfare (MoHFW)
- States that are likely to go for the insurance model are Chhattisgarh, Haryana, Uttarakhand, Jharkhand, Jammu and Kashmir, Meghalaya, Nagaland, Tripura. Union Territories of Chandigarh, Daman and Diu, and Dadra and Nagar Haveli will also opt for the insurance model.
- Those keen on adopting a trust model are Andhra Pradesh, Arunachal Pradesh, Assam, Madhya Pradesh, Bihar, Lakshwadeep, Manipur, Puducherry, Telangana, Sikkim and Goa.
- Gujarat, Himachal Pradesh, Kerala, Maharashtra, Mizoram, Rajasthan and Tamil Nadu have expressed an interest to adopt the hybrid model.
- For example, for all payments under ₹50,000, Gujarat has proposed to opt for insurance payment and for anything above it has opted for trust-based payment.
- West Bengal and Delhi chose to keep away from signing the MoU.
- Odisha will most likely not be a part of Ayushman Bharat as it wants to launch its own state-based scheme for health insurance.
Ayushman Bharat — National Health Protection Mission (AB-NHPM)
- The scheme was announced in the Budget 2018
- The scheme will provide a cover of ₹5 lakh per family per year
- There will be no cap on family size and age
- The benefits cover will include pre and post-hospitalization expenses
- All pre-existing conditions will be covered from day one of the policy
- A defined transport allowance per hospitalization will also be paid to the beneficiary