Odisha Chief Minister Naveen Patnaik launched Biju Swasthya Kalyan Yojana, a health for all scheme, on the occasion of the 72nd Independence Day on Wednesday. The scheme provides health assurance coverage to 70 lakh families, covering more than 70% of the State’s population, said Mr. Patnaik in his speech at the function held at Mahatma Gandhi Marg here.
Highlights of the scheme:
Will provide Rs. 5 lakh per family per annum for all Secondary and Tertiary Cashless Health Care Assistance. Women beneficiaries can get health cover to Rs. 7 lakh.
This scheme will benefit 3.5 crore people (70 lakh families) at any govt. and private impaneled hospitals.
All beneficiaries currently enrolled under the Rashtriya Swasthya Bima Yojana (RSBY), as well as other low-income families, are covered under the BSKY.
Odisha purposes to form a Trust to implement the scheme, which will reimburse the hospitalization cost and will not pay premiums to insurance companies. Though the Trust model saves money, the major constraints are weak in-house capacity, poor governance structure, and susceptibility to outside interference.
Another uphill task for the Trust is to improve the governance structure. Riddled with weak IT system and poor administration, the uptake of the ongoing health insurance programmes is far from satisfactory.
The Odisha State Treatment Fund has several procedural challenges, which, increases the predicament of patients. The same issues will have a major bearing on the BKSY implementation unless the Trust carefully introduces measures to lessen these problems.
The financial implication of such a humongous scheme needs deliberation. The current resource absorption for RSBY, BKKY, and OSTF is not hefty. The claims ratio for RSBY is 65-68 percent. This is unlikely to rise significantly unless an architectural correction is made.
Currently, Odisha spends around 4.5% GDP on healthcare, of which only 1.05% is by the government. Out of pocket (OOP) expenditure constitutes 76% of total health expenditure, which is unexpectedly high. On the contrary, the utilization of the public healthcare facilities is quite high, the proportion being 72.55% for outpatient visits.
Furthermore, a significant proportion of OOP is due to outpatient care, mainly due to drugs and diagnostics services (58% and 12%, respectively). Dubbed as a step towards achieving Universal Health Coverage (UHC), BSKY may provide breathing space to millions of households burdened by costly health care.
However, a large part of OOP, which occurs due to outpatient visits (71%), will not be alleviated by any insurance mechanism, as it is meant only for hospitalization.
For effective implementation of the scheme, the state needs to design the Trust structure by hiring experts to suggest packages, costs, and criteria for empanelment of private hospitals.