Government had proposed its ambitious “National Health Protection Scheme” (Ayushman Bharat) to insure the masses of India for medical expenses.
But various challenges in the sector need to be ideated upon prior to implementing the scheme for ensuring effectiveness.
What is NHPS?
National Health Protection Scheme (NHPS – Ayushman Bharat), was announced in the 2018 union budget.
While the initiative is clearly a hurried one for political reasons, it is nevertheless welcome as the crisis in the health sector is stark.
NHPS has two objectives - to enhance the health of the population and reduce the financial risk for those accessing treatment.
Success in the first is measured by a reduction in the disease burden and subsequent increase in people’s longevity.
The 2nd is to be measured by the extent of affordability of our health systems to the downtrodden and the most marginalised.
The components of the scheme are
Upgrading the 150,000 sub-centres by enhancing their services.
Providing health security (5 lakh insurance) to 40% of the population.
If implemented as integral components, these initiatives can help achieve the goals of equity, efficiency and quality in health services.
What are the challenges?
Supply Side - There is a massive shortage of health services (human resources, hospitals and diagnostic centres in both private and public sector).
This is made worse by gross inequalities between and within States.
But significantly, even a well-placed State like Tamil Nadu has an over 30% shortage of medical and non-medical professionals in government facilities.
Notably, the health budget has neither increased nor is there any policy to strengthen the public/private sector in deficit areas.
While the NHPS provides portability, it will take time for private entities to register hospitals and expand their area of operations to deficit areas.
Demand Side - The stark regional variations in health care infrastructure across states could cause patients to gravitate toward the southern States.
Growth of medical tourism (foreign patients) as a government policy is another area that is already creating significant demand.
The capacity of this infrastructure to take on the additional load of such insured patients from other States is very doubtful.
Pricing - Pricing strategy for health services under the scheme needs to be spelt out clearly as this area had proved controversial in other health too.
Notably, erratic profiteering by hospitals has been discovered under various state government sponsored insurance schemes thus far.
Mechanisms are needed to put in place to gather market intelligence and arrive at accurate pricing for medicines and medical procedures.
Primary Care - There is a proposal for upgrading primary care, but the claim seems hollow as no funding has been allocated for the same.
In the northern States there are hardly any sub-centres and primary health centres are practically non-existent.
It is estimated that Rs. 30,000 crore will have to be spent if this three-tier primary health-care system is to be brought to minimal health standards.
