The State’s anxieties over the additional expenditure that the new scheme will entail have heightened as the Centre has made it clear that it has fixed a premium ceiling of ₹1,052 for providing health cover to seniors, with the ratio of Central share to State share at 60:40.
| Photo Credit: Getty Images/iStockphoto
The implementation of the special health insurance scheme for senior citizens over 70 years of age under the Ayushman Bharat-Prime Minister’s Jan Arogya Yojana (AB-PMJAY) is likely to face a host of hurdles in Kerala as uncertainties are rife on the Central allocation for the scheme.
The new scheme for seniors’ healthcare, which envisages a health care coverage of ₹5 lakh for all seniors above 70 years regardless of their socio-economic status, is likely to have a catastrophic effect on Kerala’s finances as the State is already in the red because of the huge cost overruns of Karunya Arogya Suraksha Padhati (KASP), the integrated health financing scheme that is being run in the State in alignment with AB-PMJAY.
The State’s anxieties over the additional expenditure that the new scheme will entail have heightened as the Centre has made it clear that it has fixed a premium ceiling of ₹1,052 for providing health cover to seniors, with the ratio of Central share to State share at 60:40.
Annual expenditure
On Friday, in reply to a query raised by Idukki MP Dean Kuriakose, the Union Minister of State for Health Prataprao Jadhav said that the Centre estimated the annual expenditure of running the seniors’ health cover scheme to be ₹3,437 crore, out of which, ₹2,165 crore would be the Central share.
Mr. Jadhav said that there are 26,84,247 seniors above 70 years in Kerala as per the Centre’s estimate. He, however, gave no response to Mr. Kuriakose’s specific query whether the premium amount will be calculated for each State differently, keeping in mind the morbidity and demographic profile of the State.
Unless the Centre fixes a premium for the new scheme for seniors, which is commensurate with the individual demographic and morbidity profile of States, it will be a disaster for States like Kerala, which has a heavy burden of non-communicable diseases (NCDs), high health-seeking behaviour and one of the highest health insurance claims rate in the country.
Kerala will have to find additional funding resources to run the new scheme, even as it has no means of paying up the thousands of crores it owes to public and private hospitals empanelled under KASP, as reimbursement for the care provided.
Morbidities due to NCDs and cost of healthcare is likely to be quite high amongst senior citizens. Also, since the Centre has announced that the health cover will be provided to all above 70 years, regardless of the APL/BPL status, Kerala expects to see high registration as well as high demand for care. Already, over four lakh persons above 70 years have enrolled for the scheme, according to the State Health Agency.
Given the huge claim reimbursement overdues from the Government under KASP, private hospitals are already exiting the scheme, while cash-strapped public hospitals are on the brink of collapse.
Kerala is covering 42 lakh families in the State under KASP. However, while the Centre has been paying the premium for some 22 lakh BPL families ( as identified in SECC 2011) since 2008, the State has been on its own, paying the premium for covering the healthcare needs of an additional 20 lakh families.
But since 2020-21, when the State Health Agency decided to operate the scheme under the assurance mode or trust mode (wherein the government takes on the liability of claims settlement and reimburses hospitals for free care provided), KASP has been a huge drain on the State exchequer.
The claims expenditure which used to be contained at around ₹700 crore in the insurance mode, touched ₹1,563.35 crore in 2021-22 and ₹1,629.72 crore in 2022-23. Last year, (2023-24), the State spent ₹1570.66 crore providing healthcare, whereas the Central share in this was ₹151.34 crore.
In short, 90% of the KASP health care provision costs are now borne by the State government. The government has been highlighting the free health care that it is providing to lakhs of KASP beneficiaries, while claims over reimbursement overdues and the plight of public hospitals are conveniently brushed under the carpet.
“KASP is putting a huge strain on the government because of high utilisation. At least 6.5 lakh individual beneficiaries are seeking care through KASP in Kerala. Our hospital admission rate is 11% against the national average of 4 to 5%. We are now in the process of exploring alternate health financing models because the sustainability of KASP is in peril,” a senior Health official said
“It will be easy to implement the scheme for seniors as we are using the KASP platform and treatment packages but we still do not have a clear picture on the financial aspects. Talks with the National Health Authority are continuing,” he added.
Published – December 07, 2024 07:33 pm IST