‘Big role for private players in providing services’
Healthcare was in focus of this Union Budget 2018 with finance minister Arun Jaitley announcing “world’s largest governmentfunded health care programme”, aimed at benefiting 100 million poor families. Speaking to Hindustan Time’s Sanchita Sharma, Dr K Srinath Reddy, the president of Public Health Foundation of India, talked about the potential of the government’s healthcare scheme and the challenges it could face. Excerpts:
How will the National Health Protection Scheme (NHPS) be funded?
The Rashtriya Swasthya Bima Yojna (RSBY), which was renamed the National Health Protection Scheme (NHPS) in 2016, already has an annual allocation for it in the budget.
There is also a proposal to create a resource pool by progressively merging statefunded health insurance schemes — Aarograshri in Andhra Pradesh, Vajpayee Arogyashree in Karnataka, Bhamashah Swasthya Bima Yojana in Rajasthan, Mahatma Jyotiba Phule Jan Arogya Yojana in Maharashtra, among others — with the Central scheme with cobranding to create a large financing pool. Compared to the ₹30,000 cover offered by RSBY, some of the state schemes already offer health insurance cover between ₹1 and ₹3 lakh, and have budgets that can be merged.
Increasing the health and education cess from 3% to 4% will bring in additional funding. Also, don’t forget that many of the 50 crore people covered will not need health insurance coverage every year, so the money utilised will depend on the need.
What are the implementation challenges?
The private sector will have a huge role in providing services. National Health Policy 2017 proposes “strategic purchasing” of services from secondary and tertiary hospitals for a fee so that people can go to both public and private healthcare providers for treatment.
The Centre needs to clearly list the medical interventions and procedures and disease indications as well as standardise care to rule out the potential danger of induced care (unnecessary treatment). This is a great opportunity for setting standards of care and outcomes.
Are there best practices that can be adopted from state schemes?
States like Andhra Pradesh run the scheme through the Aarogyasri Health Care Trust, which works in consultation with specialists in healthcare.
Since the cover base will be massive, some states also use the edge that monopsony purchase (bulk buying from a single provider) gives them to negotiate and fix low prices for both medicines and essential health packages.
All the states have defined beneficiaries and many have expanded it from white cardholders (below-poverty-line families) to include other vulnerable groups.
NEW DELHI:
How can NHPS be expanded to provide health for all?
The idea is to offer a quality health insurance package that others (who are not eligible) may want to buy into. So instead of turning to private players for health coverage, people who can afford it can pay a premium and buy into NHPS, something like payroll deductions people opt for in other countries.
The Centre needs to clearly list the medical interventions and procedures and disease indications as well as standardise care to rule out the potential danger of induced care (unnecessary treatment).