Last updated: 24/3/2022

Basic Information

Country
Geographic area
Population group
Elderly persons, Ethnic groups, Women

Programme Details

Programme objectives

In India, the National Health Protection Scheme (NHPS) (or Pradhan Manti Jan Arogya Yojana) was launched in 2018 aims to provide the poorest of the population with quality secondary and tertiary care. In addition, the NHPS foresees to create 150,000 health and wellness centres to provide comprehensive primary health care, covering both maternal and child health and non-communicable diseases, including free essential drugs and diagnostic services

The objective is to provide beneficiaries with financial protection against catastrophic health expenditures and to improve access to quality health care.

Start date
2008
Previous programme name (if any)
The Rashtriya Swasthya Bima Yojana (RSBY) programme, which was under the purview of the Ministry of Labour and Employment, was shifted to the Ministry of Health and Family Welfare and renamed as Rashtriya Swasthya Suraksha Yojana (RSSY), and later was renamed again as National Health Protection Scheme in the 2017-18 budget. The NHPS also incorporated the Senior Citizens Health Insurance Scheme (SCHISC), which consisted of a top up over RSBY, that provided enhanced coverage of INR 30,000 per eligible senior citizen (aged 60 y.o. or older) per family. The RSBY targeted at BPL persons and 11 other defined categories.
Coverage
130 million beneficiaries in more than 4.1 crore (41 million) households (2017) are currently covered by RSBY, but coverage is expected to more than double, reaching out to be expanded to reach 10 crore (100,000,000) families under the National Health Protection Scheme (NHPS). Because the programe is in the process of being rolled out while the RSBY is discontinued, there are no available figures of the exact number of beneficiaries currently under the NHPS.

Targeting and eligiblity

Targeted areas
India's National Health Protection Scheme (NHPS) alone covers 98.9 per cent of all household beneficiaries in the region. It targets the 40% most deprived persons as per the following deprivation criteria used in the Socio Economic and Caste Census (SECC): Rural: families having only one room with kucha walls and kucha roof; families having no adult member between the age of 16 and 59 years; female‑headed households with no adult male member between the age of 16 and 59 years, disabled member, and no able bodied adult member in the family; SC/ST households; and landless households deriving major part of their income from manual casual labor are included in this scheme. This is roughly 7.5 crores of the total 18 crores of the rural Indian population. Other rural: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, and legally released bonded labor are automatically included under the scheme. These families account for an additional 0.16 crore rural beneficiaries of this scheme. Urban: 11 defined occupational categories are entitled under the scheme. Thus, of the 6.52 crore urban households, around 1.92 crores get included in the scheme.

Coverage and other information

Amount of benefits
The National Health Protection Scheme (NHPS) will take care of almost all secondary care and most of the tertiary care procedures. It is proposed to set up 1,50,000 health and wellness centers, from within the subcenters and primary health centers to take care of the primary health‑care element. To ensure that the umbrella of health care includes everybody, there will be no cap on family size and age in the scheme, unlike the RSBY. Priority will be given to girl child, women and and senior citizens. The benefit cover will also include pre and post-hospitalization expenses, as these were identified as one of the important out‑of‑pocket expenditures (OOPs) in literature reviewing the impact of RSBY. The NHPS foresees a family cover of INR 5 lakh (INR 500,000) per family.
Payment/delivery frequency
After receiving the smart card, beneficiaries can seek treatment in all public hospitals, hospitals belonging to the Employee State Insurance Corporation and accredited private hospitals
Benefit delivery mechanism
Selected insurance companies enroll households directly in villages and issue a biometric smart card to beneficiaries, which can be used to access cashless treatment at any public or private hospital across India which is registered with the scheme
Monitoring and evaluation mechanisms and frequency
State Nodal Agencies (SNA)/ State Health Agencies (SHA) oversee monitoring the scheme, in coordination with insurance company, hospital, and district authorities, as well as other local stakeholders. Furthermore, the National Health Protection Scheme (NHPS) will rely on a back-end data management system to track all transactions and provide analytical reports