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Ayushman Bharat ( National Health Protection Scheme)
Ayushman Bharat, the National health protection scheme (NHPS) of India, was announced in the Union budget of 2017-18. Under this scheme more than 10 crore poor people with their families will get many benefits regarding their health issues. Under this scheme people will get insurance up to RS 5 lakh per year. This scheme which will cover insurance up to RS 5 lakh will be having 50 crore beneficiaries. If this scheme is implemented it would be the world’s largest government – funded healthcare scheme. The total cost of this scheme will cover 5500-6000 crore out of which 2000 crore will be contributed by central government and remaining will be paid by different sates of the country. In India the West Bengal was the first state to renounce the membership of this scheme due to existence of state health scheme. According to state government report, this scheme has already made hospitalization and medical treatment free for its citizen and has already enrolled 50 lakh people under its programme. Under the National Health Protection Scheme, most of the secondary and tertiary treatments will be covered in both public and private hospitals. As per NITI Aayog, rural private hospitals will be encouraged to become a part of the scheme and hospitals will be provided money for improving the quality of healthcare.

Aim
The already existing Rashtriya Swasthya Bima Yojana scheme of India, which was implemented in 2008 only offers hospitalization coverage of up to Rs. 30000 to the citizens of India who have lower income. This scheme is not that effective and enough for such a big country where expenses are increasing day by day. The average hospitalization expenditure ranges from around Rs. 5000 to 30000 which is not enough and can lead to more out of the pocket expense which are almost 70% and are also not affordable by most of the population. The health standards of the people are getting threatened because of this.

In the Union Budget of 2018 the Ayushman Bharat scheme was introduced with the aim to provide financial aid in the health care sector. It was targeted for the benefit of 100 million poor families.For up to 500 million beneficiaries secondary and tertiary care hospitalization per family offering reimbursements of Rs. 5 lakhs ($7,845). All of this comprises of about 40% of the Indian population making this scheme the world's largest funded health care program by the government of India. This scheme mainly eliminates the flaws of the previous health care programs and it also ensures poor workers who work in unorganized sectors for health care insurance. Cashless treatment facilities will also be provided to the beneficiaries, they will be provided healthcare in government as well as private hospitals.

To achieve the aim of this scheme two initiatives are implemented, they are health and wellness centers and National Health protection scheme. Most of the people do not get the benefit of this types of schemes as they are only available for expensive medical treatments but this under this scheme all the citizens will be able to avail the benefits of their health expenses. There is no limitations on the size of the family and the health care coverage would be provided on the basis of the Aadhar card.

All the schemes are merged under one scheme so this scheme becomes the singer payer for health insurance care.

Phases

 * There would be three phases in the implementation process as mentioned by the Government.As per the guidelines mentioned the scheme is set to start by August 15th 2018.The packages under the scheme would be finalized by the end of April 2018.The process of documentation would be completed and finalized by the end of June 2018.

Background
National Health Insurance Scheme is an ambitious plan sponsored by the Government of India and is the world’s largest government funded programme which can save many lives and improve financial well being, it means it not only saves lives but is also cost-effective. The NHPS will have 50 crore beneficiaries. But the national health insurance scheme is a good idea initiated because India under-invests in the healthcare of its citizens and this is affecting the health and financial well being of Indians. Health-financing policy directly affects the financial protection of people and does not threaten their living standards. It is a significant move towards the universal health coverage of the citizens. The health secretary, K Sujatha Rao said “A good healthcare delivery system providing services of reasonable quality is necessary for people to take advantage of this scheme.”

Principles
Target Low Income Population The NHPS needs to conserve resources so government sponsored insurance should be provided only to those who cannot afford insurance on their own, also the number of forms people face to enroll NHPS must be minimized. Aadhaar makes it easy to verify eligibility and enroll. Aadhaar should be made readily available to demographics where it does not exist.

Contracts with Public Authorities
“The government will either have to raise public investment to strengthen its own service delivery system or incentivize the private sector by providing the necessary market,” said K Sujatha Rao.

More than 85% of the patient department care in India is from the private sector, they provide care to a large fraction of the Indian population and they need to be a part of NHPS. Private institutes might exploit NHPS, but they should be monitored and right incentives should be created instead of excluding them, only hospitals that meet certain quality standards should be allowed to serve NHPS beneficiaries and not all hospitals and secondly, NHPS should institute prior authorization for expensive medical procedures and surgeries.

Data and Evolution
Technology will be strongest point of National Health Protection Scheme. The NHPS has access to health information of more than 500 million people, all this data can be used of comparative effectiveness research or understanding which treatments work in the real world rather than just in clinical trails. It can be used to advance personalized or precision medicine. It can be used to improve the health system and understand how different delivery and financing designs affect care outcomes and costs. It can be used to improve transparency by providing information on quality of care provided by different hospitals or clinics in India.

HEALTH AND WELLNESS CENTERS:
Health and Wellness Centers are considered the foundation of India’s healthcare system, as per National Health Policy, 2017.Under this, it has been planned to establish 1.5 lac health and wellness centers to bring health care system closer to people.These would be fully equipped so that comprehensive healthcare could be provided for non-communicable diseases, maternal health and child health along with free essential drugs and diagnostic mechanisms. Rs. 1200 crore have been allocated for this flagship program in the Union Union Budget 2018. The contribution from private sector is also invited in form of CSR ( corporate social responsibility) and participation by adoption of these centers by philanthropic institutions.

New health and wellness centers will have the following features:

-Services will not be only limited to pregnancy care, immunization and some communicable diseases which constitutes only less than 10% of morbidity. However, Health and Wellness Center would cater to more than 70% of all patients including non-communicable diseases and mental illnesses.

-The onus of the doctor /specialist would start from diagnosis to treatment plan for chronic illness till follow up care.

-Each health and wellness center would require at least three full time workers along with five community health workers, each of whom should be recruited locally.

-Center would be equipped with wide range of free medicines and diagnostics

On the occasion of Ambedkar Jayanti i.e. 14th April 2018, Prime Minister of India Mr. Narendra Modi inaugurated a Health and Wellness Center in Jangla, Bijapur district, Chhatisgarh to launch the Union Government’s ambitious Health Assurance Program – Ayushman Bharat.The Prime Minister said,”the Ayushman Bharat scheme will go a long way in ending social imbalance, and ensuring social justice in the country. In the first phase of this scheme, an effort would be made to bring about a sea change in primary healthcare. the sub centers and primary health centres at 1.5 lakh places in the country would now be developed as Health and Wellness Centers”.He sees this as a major step to build the New India by 2022 and addressed these Health and Wellness Centers as family doctors for the poor.

NATIONAL HEALTH PROTECTION SCHEME:
National Health Protection Scheme is the second flagship program under Ayushman Bharat. This scheme seeks to cover over 10 crore poor and vulnerable families which means a total of about 50 crore beneficiaries. The coverage of upto 5 lakh rupees per family per year would be provided for secondary and tertiary care hospitalization. This will be the world’s largest government funded health care program. Due to the large extent and scale of this program, on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana ( RSBY) and Senior Citizen Health Insurance Scheme (SCHIS) would be subsumed under this program.

Implementation
When Mr. Arun Jaitley, the finance minister of the country launched the National Health Protection Scheme on 1st February 2018, The world’s largest government funded healthcare programme targeted to cover over 10 crore poor and vulnerable families by providing coverage up to Rs 5 lakh per family per year for secondary and tertiary care hospital. The scheme was aimed to reduce water borne diseases and make India a better place in terms of its medical and healthcare facilities. It is also aiming to provide government sponsored health insurance to 500 million people in the country which is roughly about 40% of the population of the country. The idea for the scheme is just brilliant because of several reasons, the out of pocket payments for standard healthcare facilities in our country is so high that only a minimal amount of people can afford it. This causes impoverishment to around 7% of the population also leading to death of some. Also, not all schemes and insurance policies of the government healthcare duty are successful, there is sufficient evidence that if this gets implemented well, it can improve the healthcare, financial well-being and save lives. A study in 2011 from IISEC showed that over 21% of the annual income of the citizens was lost in ailments, especially amongst poor people or people with fewer facilities of such, both in urban and rural areas. Its implementation also aims at the growth of financial sector as health-financing policy directly affects the financial protection of people when direct payments that are made to obtain health services do not threaten their living standards.The ministry of health has also called the meeting of several state health secretaries to get their suggestion on the implementation of this mega scheme. As it is different from many other schemes and is a huge programme to be implemented on a large scale between the masses, the insurers are keen that they shouldn’t suffer any losses; hence the government is also providing Rs 2000 croreout of the 5000-6000 crore budget for the same. The implementation will also involve meetings and questions as to how much the centre and the state government will split the financing ratio, and how this scheme can also cause development of the country in other state and central government schemes. Amidst of all this, the national health protection scheme, also called the “modicare”, if implemented properly, has the potential to become the cornerstone of India’s healthcare needs for several future generations.

Related Schemes
National health protection schemes in other countries as compared to India are as follows, in Canada the administration Fund Medical coverage, and the private segment conveys a considerable measure of the care. Numerous Canadians have supplemental private protection through their business to help pay for professionally prescribed medications, dental specialists and Optometry. The 70% of the Government spending in on Health care. As compared to India, Britian the governemnt provides care also to people and the National Health Service (England). Scope is wide, and most administrations are allowed to residents, with the framework financed by charges, however there is a private framework that keeps running close by people in general one. Around 10 percent purchase private protection. Government spending represents in excess of 80 percent of all human services spending.

As compared to India, United states has a blend of conflicting thoughts: private protection through work; single-payer Medicare (United States) mostly for those 65 and more seasoned; state-oversaw Medicare for some, low-salary individuals; private protection through trades set up by the Affordable Care Act; and additionally around 28 million individuals with no protection by any stretch of the imagination. Doctors facilities are private, aside from those keep running by the Veterans Health Administration. As compared to India ,Singapore has a fundamental care in government-run healing facility wards is modest, in some cases free, with more choice care in private rooms accessible for those paying additional. Singapore's specialists contribute around 37 percent of their wages to their Savings account that might be spent on medicinal services, lodging, protection, speculation or instruction, with part of that being a Business commitment. As compared to India ,Australia gives free inpatient mind out in the open healing facilities, access to most medicinal administrations and doctor prescribed Medications. There is likewise deliberate private medical coverage, offering access to privateClinics and to a few administrations general society framework does not cover. The government  pays for no less than 85 percent of outpatient administrations, and for 75 percent of the medicinal expense plan for private patients who utilize open doctor's facilities.