Ayushman Bharat approved by Cabinet but may need Rs 20,000 crore injection in first year: Insurance Actuaries
Ayushman Bharat, Modi government’s ambitious healthcare scheme for the poor, would require as much as Rs 20,000 crore in the first year with the number rising to Rs 50,000 crore in later years given the extent of coverage, insurance actuaries said.
“Depending on experience, pricing will be calibrated with the maturity level of the health insurance scheme,” said an actuary with a large general insurance company.
“The premium would be around Rs 2,000 per family to start with; in the long run it can go up to Rs 5,000 per family.” This will take care of almost all secondary and most tertiary care procedures.
The premium could be high as the government intends to cover all existing illness and diseases, they said. Insurance companies in general charge lower premium for those with no current illness. The amount is also based on the kind of diseases covered.
The union cabinet on Wednesday approved the Ayushman Bharat -National Health Protection Mission that aims to cover as much as 10 crore families. If implemented, this would be the biggest such programme in the world. The central and state government will share the premium in the 60:40 ratio.
When the price discovery is made through the tender process, the premium will be high for states where utilisation is high. Experience under the decade-old Rashtriya Swasthya Bima Yojana (RSBY), which enrolled more than 30 million families below the poverty threshold, varies from state to state.
“If you have one premium for all states, then some states would be overpaying or others underpaying,” said another actuary. “One premium will lead to cross-subsidisation. Enforcing exclusion will be difficult. Although it is a Rs 5-lakh cover, premium will depend on the average payout. The cost will depend on the assumptions.” The premium that companies would charge the government would also depend on factors, including benefits provided. If maternity, pre-existing diseases and waiting period is waived off, than the pricing will go up.
The pricing would also depend on states’ bargaining power of the states – whether they float tenders individually or collectively.
Many states are already running their health insurance schemes like Aarogyasri in Andhra Pradesh, Mukhyamantri Swasthya Bima Yojana in Jharkhand & Uttarakhand, Biju Krushak Kalyan Yojana in Odisha and Comprehensive Health Insurance Scheme in Kerala. Whether the states would continue to run these programmes, or adopt Ayushman Bharat, is not clear yet.
