Kerala has signed a memorandum of understanding (MoU) with the national health protection scheme, Ayushman Bharat-Prime Minister Jan Arogya Yojana (AB-PMJAY). But as decided earlier, the government will implement the scheme in alignment with the State’s new comprehensive health insurance scheme, Karunya Arogya Suraksha Paddhati (KASP).
The State had been undecided about joining the AB-PMJAY despite the promise of an increased coverage of ₹5 lakh per family. The State would not have been able to run the scheme at the premium of ₹1,100 offered by the Centre.
In addition to this, while AB-PMJAY would cover only 20.54 lakh families, the State would have to find funds to cover the additional 19.4 lakh families it has already been covering under the current comprehensive health insurance scheme (RSBY-CHIS).
The RSBY-CHIS ends in March 2019, when the new KASP-PMJAY scheme comes into effect.
In June, the government had announced the proposed integration of the existing health insurance and assurance schemes run by various departments into a pre-payment programme — KASP.
The merged schemes include RSBY-CHIS, CHIS Plus, Karunya Benevolent Fund, Sukrutham, Thalolam and Arogyakiranam.
KASP, in alignment with AB-PMJAY, will give financial protection to approximately 40 lakh households in the State and cover all major secondary and tertiary medical care services, including the treatment of cancer or cardiac diseases, in all empanelled public or private hospitals.
Expert committee
As part of rolling out the programme, the government had appointed an expert committee with D. Narayana, the Director of Gulati Institute of Finance and Taxation, as the chairman to finalise the comprehensive list of benefit packages and costing for KASP.
It is learnt that the committee would be submitting the report soon, following which the implementation modalities of KASP-AB-PMJAY will be finalised.
PMJAY has defined 1,354 medical packages covering 651 super speciality procedures in 23 categories of illnesses. The Narayana committee is studying these packages and according to experts, a more comprehensive medical package, providing a whole range of hospitalisation services, is being proposed under KASP.
Flexibility
Under AB-PMJAY, the States have the flexibility when it comes to implementation and to choose the model they want to work with — Trust model, insurance model or the mixed model. Most of the other States which joined AB-PMJAY have opted for the Trust model.
Kerala will decide this only when the implementation modalities are finalised. The State Health Department will be the nodal department, under which a State Health Agency will have to be set up as the implementing agency.
The most crucial factor for the successful implementation of a health insurance programme of this magnitude is a robust institutional mechanism with a high level of technical expertise.
States such as Andhra Pradesh and Tamil Nadu have established Health Insurance Trusts, with sound technical expertise and IT machinery for monitoring and evaluating the insurance programmes.