[Model Answer] UPSC GSM2: Ayushman Bharat-NHPM: Features, Fiscal & Administrative challenges (250 words, 15 marks)

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Majid Hussain
  1. Mock Question for UPSC Mains GS2
  2. Introduction (Origin / Data)
    1. Body#1: How different from predecessors
    2. Body#2: Fiscal Challenges
    3. Body#3: Administrative Challenges
  3. Conclusion (futuristic note: yes positive step)
  4. Mistakes and Self-Assessment Benchmarks (SAB)

Mock Question for UPSC Mains GS2

How is Ayushman Bharat-National Health Protection Mission (AB-NHPM)  different from the previous centrally sponsored schemes  on health insurance? Identify the fiscal and administrative challenges  in its implementation. (250 words, 15 marks)

राष्ट्रीय स्वास्थ्य संरक्षण मिशन इससे पूर्व की केंद्र सरकार द्वारा प्रायोजित योजानाओसे अलग कैसे है? इस योजना को लागू करने आनेवाली वित्तीय व् प्रशासनिक चुनौतियो को चिन्हित कीजिए.

Relevance to UPSC GSM2-Syllabus? Issues relating to development and management of Social Sector/Services relating to Health.

Introduction (Origin / Data)

  • (Origin) The Ayushman Bharat -National Health Protection Mission (AB-NHPM) was announced in the Budget-2018. This scheme has two components: (1) Health and Wellness Centers. (2) National Health Assurance Scheme known as Pradhan Mantri Jan Arogya Yojana (PMJAY).
  • This centrally sponsored health insurance scheme is different than its predecessors / other schemes in following manner <BODY PART#1>

OR we can introduce by DATA:

  • (DATA): NSSO:  In-patient hospitalization expenditure in India has increased nearly 300% during last ten years. More than 80% of the expenditure are met by out of pocket (OOP). Rural households meet this expenditure through ‘household savings’ (68%) and on ‘borrowings’ (25%), perpetuating the vicious cycle of poverty. Hence In budget 2018, NHPM was announced… (THEN INSERT ORIGIN, so you’ll realize that it was much better to directly jump to origin and use such data to appreciate the scheme in conclusion!!)

Body#1: How different from predecessors

Previous schemes NHPM
Rashtriya Swasthya BimaYojana (RSBY): only BPL family. Only annual Rs.30,000 insurance. Here Rs. 5 lakh medical insurance per family per year. SECC-2011 data to cover more than 10 crore families.
ESIC’s schemes cover only workers and their families (NOT FARMERS), Senior Citizen Health Insurance Scheme (SCHIS) covers only senior citizens (NOT INFANTS) Here all age groups and occupation groups covered.
State Government too have their own medical insurance schemes such as Gujarat’s Mukhyamantri Amrutam (MA) Yojana. State Governments will be allowed to expand AB-NHPM both horizontally and vertically by adding their own funds.
These features were missing in previous schemes:
  • Cashless paperless treatment in secondary- and tertiary-care hospitalisation both in public and private hospitals.
  • Both pre and post-hospitalisation expenses, Transportation cost also provided.

Body#2: Fiscal Challenges

  • Rs. 25,000-40,000 crores required to fully implement the scheme in letter and spirit. Government has also hiked MSP to double farmers’ income. So, difficult to manage the fiscal deficit targets under FRBM Act.
  • Cost sharing between Union and States: 60:40 (ordinary), 90:10 (Special category states). But some states reluctant / already have better schemes of their own.
  • Inflated costs, connivance, corruption.
    • Janani Suraksha Yojana (JSY) was launched to pay for institutionalized deliveries of poor women to reduce Maternal Mortality Ratio (MMR). But private doctors deliberately perform Caesarean surgeries to avail more money from Government.
    • In Delhi a case where Rs.15,00,000 rupees extracted for 15 days’ dengue treatment for a girl.
    • Yes, NHPM has ceiling of Rs.5,00,000 but there is a danger of private clinics inflating the costs, tests and medicines even for ordinary ailments to extract maximum amount of that annual 5 lakh rupee coverage per family.

Ayushman Bharat-National Health Protection Mission (AB-NHPM)

Body#3: Administrative Challenges

  • CAG observed that 46% of Gujarat’s BPL families don’t have the cards for Gujarat state’s own health insurance scheme! Door to door, village to village enrollment of the beneficiaries will require large manpower.
  • Improving Doctor to patient ratio. Physical and IT infrastructure, transport & connectivity upto village level. These issues pose both financial and administrative challenges. Often, we see disturbing images of poor schedule tribes in Odisha bringing their pregnant wives and injured kids on bicycle or shoulders for kilometers because there is no hospitals or ambulances in their vicinity.
  • PM Fasal Bima Yojana- another ambitious scheme that provide crop-insurance to farmers. But there have been many complaints that private insurance companies are not paying the assured sum on time, in pretext of technicalities. Therefore, effective monitoring and grievances redressal mechanism will be necessary for the success of NHPM.
  • To remove corruption, we’ll have to link the beneficiaries Aadhar numbers with their medical records. Reliance on contractual-staff in this exercise, may violate the medical privacy of patient, their database may be misused by the pharma companies for their clinical trials and commercial motives.
  • Specialized personnel will be required for empanelment and supervision of private hospitals in this scheme.

Conclusion (futuristic note: yes positive step)

  • Sustainable Development Goal SDG#3 Ensure healthy lives and well-beings at all ages. NHPM is a right step in this regard, provided aforementioned challenges are addressed. OR
  • Disease burden robs a poor person of his wages and savings. If aforementioned challenges are addressed, NHPM can greatly help in poverty removal and human development in India. OR
  • If above challenges are addressed, NHPM can improve health outcomes, productivity, efficiency of Indian population, thus leading to improvement GDP and in quality of life.

Mistakes and Self-Assessment Benchmarks (SAB)

Parameter Marks Benchmarks
Introduction 0-1-2
  • +2: marks if it contains keywords: Budget2018, two components.
Conclusion 0-1-2
  • 0: if ending on a negative tone that instead of NHPM, we should come up with detailed reforms in healthcare sector as suggested by the Niti Aayog.
Body 0 to 4 marks
  • Not more than 2 marks written only fiscal deficit and doctor shortage.
Logical structure -1 to 0
  • (-1) if Administrative and Fiscal challenges are not bifurcated in two different lists.
  • (-1) Extremists negative statements like- NHPM faces IMPOSSIBLE and insurmountable challenges. It’s impossible to prevent corruption in this. W.Bengal, Kerala and other non-BJP states will NEVER agree for this. अगर इतनी ही नकारात्मक भावना है तो आई.ए.एस. बनकर जिस योजना में आपको यकीन नही है उसको अपने जिले में  से लागू करने में आप आलस्य दिखाएँगे. #NOT-Officer-LIKE-Quality.
Concise expression -1 to 0
  • (-1) if digressing with longwinded emotional outcry about how disease burden robs a poor family of its savings and wages.
Language -1 to 0
  • (-1) If using English words in vernacular language.
Total Marks out of 15 0 to 8
  • After adding / subtracting above parts, give yourself NOT less than zero and not more than eight marks.

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One Comment on “[Model Answer] UPSC GSM2: Ayushman Bharat-NHPM: Features, Fiscal & Administrative challenges (250 words, 15 marks)”

  1. how to download this in pdf.. help

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