America has Obamacare, India to have Modicare, Meghalaya has MHIS

Written by Meghalaya Times. Posted in Editorial

Thomas Lim
Terming it as the world’s largest government-funded healthcare programme, Union Finance Minister Arun Jaitley on February 1, 2018 announced the National Health Protection Scheme under which Rs 5 lakh cover will be provided a year to 10 crore poor and vulnerable families in the country. The common citizens through social media have begun to call the healthcare insurance plan announced in the Budget ‘Modicare’ along the lines of ‘Obamacare’ - long before the finance minister did, but when Arun Jaitley on Doordarshan referred it to as ‘Modicare’, he made sure that this is what it will come to be called henceforth.
The National Health Protection Scheme, Under the Ayushman Bharat, dubbed not ‘Modicare’ but ‘NaMocare’ by BJP President Amit Shah, will be a government-funded health care programme. It is aimed at providing health insurance cover of up to Rs 5 lakh per family per year to 10 crore poor families. That accounts for roughly 40 per cent of the country’s population. This scheme addresses secondary and tertiary care hospitalisation and covers both prevention and health promotion.
It is estimated that around 23 million Americans gained health insurance coverage from Obamacare. This is the biggest USP of Obamacare, where insurance firms couldn’t turn down, or overcharge, people with pre-existing medical conditions. Obamacare had hit rock bottom and as soon as Donald John Trump came to power, he had attempted to repeal Obamacare but failed.
Meghalaya Chief Minister Dr Mukul M Sangma, reacting to the Budget had thanked Prime Minister Narendra Modi for replicating the Megha Health Insurance Scheme, one of the flagship programmes launched by the state’s Congress government, on the national level.
The Central government in fact invited the State government to present this exemplary health initiative to other states. Dr Sangma while noting that Megha Health Insurance Scheme is one of the transformations in the state’s health sector, said there is no programme as inclusive as the one in Meghalaya, where the scheme is not confined only to BPL (Below Poverty Line) families, but is extended to everybody.
It may be recalled that Health services in Meghalaya have always been in the eye of the storm; the disparities between the haves and the haves-not were so evident, as the health services were so expensive, private treatment was not at all affordable for the rural folks and the working classes of the state while the affluent section preferred treatment outside the state, and even abroad.
The launch of the Megha Health Insurance Scheme (MHIS) was like a boon to the economically weaker sections of the society, but due to the high cost of medication, under the last two phases it was found difficult to renew the services from the stakeholders.
The Government of Meghalaya, this time with the support from the Union Ministry of Health and Family Welfare, on April 3, 2017 signed an agreement with New India Assurance Company Limited, a general insurance company in India, to roll out the enhanced phase-3 of the Megha Health Insurance Scheme (MHIS 3) to provide a comprehensive and universal health insurance cover to the entire population of the state.
In the past other Insurance companies which had rendered the services claimed to have incurred a huge loss, almost to the tune of Rs 2000 crore, just paying for the claims of treatment. The stakeholders and the Health Department of Meghalaya had never anticipated the high cost of medication, and also the prevalence of sickness in the state, particularly from the rural sectors.
Above that, almost all of the MHIS card holders have exhausted the assured amount for medical treatment, between the last phase and the third phase, many who have got accustomed to the better health services were suffering as they could not afford to continue the same treatment.
This time, the agreement signed in Shillong between CEO, Megha Health Insurance Scheme and Secretary, Department of Health and Family Welfare, H.M Shangpliang, and Senior Divisional Manager, New India Assurance Company Limited.  B.K Das is based on the Government of India’s existing national health insurance scheme - Rashtriya  Swasthya Bima Yojana (RSBY) with an enhanced coverage of upto Rs. 2,80,000 and an  additional Rs. 30,000 coverage for each Senior Citizen.
MHIS-3 assures that residents of Meghalaya will now be able to avail a comprehensive spectrum of health services including super-specialty treatment, advanced diagnostics, comprehensive outpatient services for pregnant women and children and long term consultation and treatment services for lifestyle diseases such as diabetes and heart disease on a free of cost basis subject to limits.
In the past it was with limited services, although it did serve the purposes well, except with few complaints while many deserving sections of the society were not covered, the renewal of the services needs to be extend to the left out sections in the last two phases, meaning the fund too needs to be enhanced.
With the exceeding of the allotted fund in the last two phases, the insurance companies have incurred a loss. In order to avoid similar hiccups as in the past, funds for the Megha Health Insurance Scheme need to be raise by involving more stakeholders, leveraging on Corporate Social Responsibility (CSR), all the Telecommunication Services, Supplier of all essential commodities to the state, banking institutions, constructions companies and a few of the Semi Government agencies. This can be along the lines of the Swachh Bharat Abhiyan, where every individual is being taxed to raise the clean India campaign.
The additional fund will definitely be required as this Phase 3 has been designed to fully integrate with the existing public health system in Meghalaya. The scheme will also significantly expand the number and quality of specialty and super-specialty hospitals available to the people of Meghalaya by requiring the empanelment of super-specialty hospitals across major metropolitan cities in India with emphasis on National Accreditation Board for Hospitals & Healthcare Providers (NABH) accredited hospitals.
Hopefully this will not be extended to the elite section of the society as coverage of all sections of the society is the only way that this mission will achieve its purpose. It is evident that the MHIS is a great boon to the economically weaker sections of the society and it is only be ensuring that the scheme reaches its intended beneficiaries that the earlier hiccups can be avoided.
This time the National Health care will have Centre State share of 60:40, and a paperless transaction, to be linked trough Aadhaar, hopefully will surely improve the healthcare across the nation.


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