What lessons can the National Health Protection Scheme take from the Maharashtra's Rajiv Gandhi Jeevandayi Aarogya Yojana for the accomplishment of its objectives?

Published: March 29, 2018

National Health protection scheme is a flagship scheme of the Union government under which the government aims to provide insurance of up to Rs. 5 lakh each for 10 crore poor and vulnerable families for hospitalisation. It is a step towards achieving universal health insurance.
Rajiv Gandhi Jeevandayi Aarogya Yojana is one of the successful schemes of the Maharashtra government. This is a universal coverage scheme that benefits 2.23 crore poor households which covers around 95 per cent of the state’s population. An insurance cover of Rs 1.5 lakh per year is provided to each insured family.
Lessons for National health protection scheme

  • Coverage: Selecting the beneficiaries for NHPS would be daunting task. The government must try to provide universal coverage to the poor households even by charging minimal amount like in Rajiv Gandhi Jeevandayi Aarogya Yojana to prevent the exclusion errors.
  • Developing the disease profiles of the states so has to aid in identification of the procedures to be covered under the scheme. The selection of the services for insurance cover will have a bearing on the sustainability of the scheme.
  • Selection of the insurance provider must be undertaken carefully. Each step — such as the design of the tender documents, contracts and legal agreements, payment terms, penalties for non-compliance, pre-qualifications of bidders, prior experience, e-tendering process, whether private sector companies would be allowed to bid, whether tenders would be called state wise or nationally — must be considered carefully. Otherwise, it could invite legal challenges.
  • Accreditation of the Hospitals for the scheme: Maharashtra selected 492 hospitals consisting of 78 government institutions and 414 private institutions. The selection of hospitals would be a key process to ensure the success of the scheme. Or else the scheme would meet the same fate as Rashtriya Swasthya Bima Yojana (RSBY) whose loopholes were flagged by CAG.

21st century is an era of cooperative federalism for India. Many states like Maharashtra, Karnataka, Rajasthan, Andhra Pradesh, Goa and Tamil Nadu, have successfully experience of implementing health insurance programmes which covers over 50 crore people. Central government must learn from the experiences of these states to reduce the out of pocket expenditure for health and increase the viability of NHPS.

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