As India moves towards the achievement of Universal Health Coverage (UHC), finding robust and evidence-based answers to the challenges of defining which services should be publicly funded, for whom and how, becomes increasingly important. The introduction of ‘Modicare’, the nascent health insurance scheme announced out by the Indian Federal Government to cover some 500 million citizens, brings with it a complex collection of challengers for State policy-makers to address. These include an urgent need to rationalise multiple insurance schemes, their benefits and their purchasing and contracting strategies; and enhance quality monitoring, to assure that public subsidies for health insurance are being well spent and maximising population health gains. 

A workshop was held on 25 and 26 February 2019 in Guwahati, Assam, in the North East of India to address some of these pressing issues. The workshop was co-hosted by the Government of Meghalaya, the Indian Institute of Public Health Shillong and iDSI partners from the Center for Global Development and Imperial College London. 

The two-day event was opened by Shri Samir Sinha, Principle Secretary Health, Government of Assam, and brought together over 50 participants from six of the North Eastern States. Delegates represented local government, and academic, non-government, and multi-lateral organisations such as the World Health Organization, The World Bank, Bill and Melinda Gates Foundation and UNICEF. 

This international interactive workshop was the first event of its kind to be held in the North East of India and provides an important opportunity for iDSI to explore and strengthen collaborative engagement in this region; and for North Eastern States to showcase their proactive engagement towards health system strengthening. 

The workshop sought to explore international best practices for defining and implementing successful Health Benefits Packages, highlight common pitfalls and share lessons for success – drawing from the iDSI publication ‘What’s in, what’s out: Designing Benefits for Universal Coverage’. Presentations and practical group work sessions provided some answers, options and choices in response to the important challenges that State governments are facing in relation to the refining of their own State Insurance Schemes and design of their health benefit packages. 

A recent collaborative analysis of the Meghalaya Health Insurance Scheme (MHIS) by IIPH Shillong and Imperial College London was presented for the first time. This analysis tracked the scheme’s evolution and enhancement as the State progresses towards improving population health and highlighted key areas for development under the next phase of the MHIS.

Reflections from the workshop are summarised in this slideset.

Workshop materials

Presentations

Day 1

• Amanda Glassman, CGD: What’s In, What’s Out: Designing and Adjusting Health Benefits Plans for UHC
• Amanda Glassman & Kalipso Chalkidou, CGD: What is your HBP policy baseline?
• Amanda Glassman, CGD: Fiscal and budgetary issues for HBP
• Owen Smith, The World Bank: Using evidence to strengthen HBP implementation under PMJAY
• Sampath Kumar, IAS, Government of Meghalaya: The Meghalaya Community Participation and Public Services Social Audit Act, 2017
• Laura Downey, Imperial College London & Peter C. Smith, Imperial College London and University of York: Reviewing the health benefits package in Nelam Pradesh: methodology case study
• Peter C. Smith, Imperial College London and University of York: Methodological options for setting the health benefits package

Day 2

• Guwahati, National Health Authority: Governance under AB PMJAY
• Amanda Glassman, CGD & Ursula Giedion: Principles of good governance for a sustainable HBP policy
• Roshan Ronghang, IIPH Shillong: Assessing the pattern of enrolment and claims in Megha Health Insurance Scheme (MHIS)
• Anuj Gupte, MD India Health Insurance: HBP design and implementation overview
• Kikameren Longkumer, Department of Health and Family Welfare, Nagaland: Universal health coverage and health benefit package: Nagaland state
• Carleigh Krubiner, CGD: Navigating ethics in the design of health benefits. Evidence-informed practices to promote equitable and ethical progress on the path to UHC
• Prof Rama V. Baru, Jawaharial Nehru University: Equity and ethical considerations in health technology assessment

Group work case studies

• Case study: Reviewing the health benefits package in Nelam Pradesh
• Case study: Ensuring good governance in HBP design and implementation
• Case study: Examining ethics and equity dimensions in efforts to reduce maternal mortality

Press coverage

International conference on health finance – The Shillong Times, 9 March 2019

1. The poor are the primary beneficiaries of this scheme

Modicare’ s predecessor, the government-run health insurance programme Rashtriya Swasthya Bima Yojana (RSBY), covered only those identified in the national census as below the World Bank-defined ‘poverty line’ of $1.90 per day. Under Modicare, coverage criteria will expand to include identified occupational categories of urban workers’ and their families.

2. The scheme covers secondary and tertiary care only

There are approximately 1,500 secondary and tertiary care procedures nominated in the package of services covered under the scheme.

3. Responsibility for financing the scheme will be shared between the Central and the State governments

Purchasing will occur through a State-run trust fund or a market-driven tendering process. The States will be given flexibility over the financial administration of the scheme. 

4. Beneficiaries can avail benefits in both public and empanelled private facilities

States will be given flexibility over choice of care providers and means of purchasing and procurement.

5. The Scheme will pioneer the use of a novel digital information capture system

Utilising India’s biometric ID scheme, ‘Aadhar’ identification cards will be used to capture details of enrolment, claims and reimbursement activity in each State.

The rollout of such an ambitious scheme in a country as large and diverse as India faces challenges, including the identification of and outreach to beneficiaries; putting in place adequate governance and regulatory mechanisms to reduce fraud and low value care; and making sure finances allocated to provide for the scheme match local need.

Ensuring the delivery of high quality of care will perhaps be the most important challenge to address, given India’s recent ranking in terms of quality and accessibility of healthcare in the Lancets’ Global Burden of Disease study.

Nevertheless, Modicare represents a unique opportunity to provide access to healthcare to a population that sorely needs it, moving India one step closer to Universal Health Coverage and bridging economic, gender and social divides.

The scheme is due to launch next week on 25 September.