The otherwise non-descript room in Nirman Bhavan, the headquarters for the Union health ministry, is at the centre of the action. A large whiteboard gets updated almost on a real-time basis, with data flowing in from states. But, will the prime minister (PM) launch the mega health scheme on Independence Day?
To that, former bureaucrat Bhushan, who criss-crossed 10 states in the past 10 days to iron out hurdles, refused to give a straight answer. “Our team has been working from 9 am to 9 pm to keep things ready for a roll-out,’’ is all that he said.
Sources, however, indicated that PM Narendra Modi’s Independence Day speech would indeed talk in detail about Ayushman, which is being projected as the next big thing after the goods and services tax (GST) for the National Democratic Alliance (NDA) government. There is a note of caution though from the government — Ayushman should not repeat the software glitches that the GST encountered at its roll-out.
At least six states — Chhattisgarh, Manipur, Haryana, Gujarat, West Bengal, and Andhra Pradesh — are on board for a pilot of the Ayushman. The PM would dedicate it to the nation on Wednesday from the ramparts of Red Fort, said sources adding that the pan-Indian launch will have to wait. While October 2 is one of the dates being considered for a countrywide launch, it could happen earlier.
Even as the Union Budget had introduced the ambitious scheme with a budgetary support of Rs 105 billion as the Ayushman Bharat National Health Protection Mission, it is tipped to undergo a name change. The suggestion is for Pradhan Mantri Jan Arogya Abhiyan (Prajaa). It could not be confirmed if a decision has been taken on this.
The name is not the only change. The basic model of the scheme too is in the midst of transformation even before it is launched. Sources said politics, ahead of a number of state polls and 2019 Lok Sabha election, has played a significant role in how Ayushman or ‘Modicare’ or Prajaa would play out.
Initially, it was planned as an insurance-based model, but now most states have tilted towards the trust model, where insurance companies would not have any role at all. Against a premium-based format in the insurance model, the trust concept would mean the government (Centre and states) will bear the entire cost. Also, there would be a mix or a hybrid model, a combination of insurance and trust. People in the business pointed out that the hybrid model was likely to be the most successful. To ensure a smooth roll-out, J Satyanarayana, UIDAI chairman and former aide of Andhra Pradesh Chief Minister Chandrababu Naidu, has been brought in as an advisor for the scheme. Tata Consultancy Services (TCS) is spearheading the on-ground technical matters, along with the NIC and information and technology ministry.
In his interactions on Ayushman, the PM is believed to have underscored the need to minimise cases of fraud and abuse. A separate regulator is a possibility that is being talked about. Although people working on the scheme realise the limitation of a list of beneficiaries (around 100 million families) that was prepared seven years ago, the government is unlikely to open it for revision ahead of elections, fearing controversies, sources pointed out.
Till now, 28 states and Union territories (UTs) have signed up to be a part of Ayushman, and some of them already offer health schemes at the state level. As the benefit offered by states is often much lower, the total health cover would go up to Rs 500,000 an annum per family, as states join the Centre’s initiative.
The cost will be split between the Centre and states. Much of the beneficiary data for Ayushman has been sourced from Rashtriya Swasthya Bima Yojana (RSBY) and the state health schemes, as there is an overlap.
By August 15, the target is to enroll 8,000 hospitals under the scheme across the 28 states/UTs. At present, the number is a little more than 7,700. At the time of pan-Indian roll-out, the number of hospitals could go past the 20,000 mark, Bhushan said.
Odisha, one of the states staying out of the scheme, could join in after the state election later this year. Others in the process of joining in include Tamil Nadu, Maharashtra, Karnataka, Kerala and Punjab.
Delhi is unlikely to be a part of the scheme anytime soon, sources said. The review meeting at 10 am everyday in the Nirman Bhavan war room often springs surprises.