Given Aadhaar’s proven track record in ensuring no leakages in various welfare schemes, it is not surprising the proposed National Health Protection Scheme (NHPS) talks of using Aadhaar in identifying beneficiaries at the time of hospitalisation. What is worrying, however, is that the consultation paper circulated for discussion with various stakeholders is somewhat ambiguous about whether this will be compulsory. So, at one place, the document says “The beneficiaries will be encouraged to bring Aadhaar for the purpose of identification”. And while it has the standard disclaimer, “However, no person will be denied benefits under the scheme in the absence of Aadhaar”, among the roles and responsibilities of the nodal State Health Agency (SHA) is “Aadhaar seeding”. But then, to add to the confusion, the rules talk of how the ration card number will be collected from potential beneficiaries—10 crore households to be identified by the SECC lists—and that, apart from Aadhaar, any other valid government document/ID will be accepted. In another place, the consultation paper talks of how, if the beneficiary does not have an Aadhaar, he will need to produce either an Aadhaar or an enrolment slip for the next treatment. Given the large potential for fake claims, the government has to ensure the exceptions to Aadhaar-based biometric IDs are very minimal; more so since, by now, over 90% of Indians have Aadhaar IDs.
Another potential source of worry that the insurance companies flagged in their meeting with the government last week relates to de-empanelment of hospitals accused of fake operations or other such malpractices. It is understandable that the government would not want to leave this completely in the hands of the insurance companies who have a vested interest in de-empanelling hospitals since that will keep the claims under control, but it is equally important not to go the other way. The roles of the State Empanelment Committee (SEC) and the District Empanelment Committee (DEC) are critical in this process. The SEC, however, has just one nominee of the insurance company among its—at least—six members while one of three DEC members will be from the insurance company. Ideally, the insurance companies should have an equal weight in the panels to ensure their objections are not over-ridden. Another deal-breaker was, in the past, the chance that the government was looking to cap the premium at around Rs 1,000 or so per family while the insurance companies argued that a much higher premium would be required—as FE reported on Monday, the government has now clarified that this applied only to the central government’s contribution and that any amount over this would be paid by the state government. In a flagship scheme of this sort, it is important the government spend enough time to get all major kinks/ambiguities sorted out at the earliest.