India Today - - NEWS - (Aroon Purie)

Few politi­cians can beat the am­bi­tion and au­dac­ity of schemes con­ceived by Prime Min­is­ter Naren­dra Modi. The lat­est one is the an­nounce­ment by Union fi­nance min­is­ter Arun Jait­ley in this year’s bud­get of the Na­tional Health Pro­tec­tion Scheme, or Ayush­man Bharat.

This tax-fi­nanced health in­sur­ance scheme for the poor will give 100 mil­lion poor fam­i­lies, or around 500 mil­lion peo­ple, a Rs 5,00,000 cover per fam­ily per an­num. It is the world’s largest health­care scheme. Modi­care, as it’s now be­ing called, will pro­vide state-funded health­care to a pop­u­la­tion big­ger than that of South Amer­ica. Prime Min­is­ter Modi, known for his big ideas, called the scheme ‘a path-break­ing ini­tia­tive to pro­vide qual­ity and af­ford­able health­care’ and said it would usher in a ‘par­a­digm shift in our health sec­tor’.

This is very laud­able. Rarely have health and ed­u­ca­tion be­come is­sues for po­lit­i­cal de­bate, which could, in a way, ex­plain the rot­ten state of health and ed­u­ca­tion over the last few decades. Politi­cians have been happy to seek votes on di­vi­sive, emo­tive is­sues like caste and re­li­gion. Yet, as is the case with all other large state­spon­sored schemes, there are se­ri­ous is­sues with the pro­posed im­ple­men­ta­tion of this gi­gan­tic scheme.

The pa­thetic state of health­care is one of In­dia’s biggest pol­icy blights. Seventy years af­ter in­de­pen­dence, 86 per cent of ru­ral In­dian pa­tients and 82 per cent of ur­ban pa­tients do not have ac­cess to any form of em­ployer-pro­vided or state­funded in­sur­ance.

The link be­tween health and wealth is a fact that should be more widely ac­knowl­edged. One-sixth of In­dia’s poverty bur­den re­sults from out-of-pocket health ex­pen­di­ture, which also de­ters the poor from seek­ing treat­ment. Sixty-three mil­lion In­di­ans (that's more than the pop­u­la­tion of Kar­nataka) are pushed into debt due to health­care spend­ing each year. In­di­ans are tor­mented by a twin-pronged dis­ease threat—tra­di­tional ail­ments like di­ar­rhoea and tu­ber­cu­lo­sis—and life­style or non-com­mu­ni­ca­ble dis­eases like obesity, di­a­betes and heart ail­ments. A bro­ken health­care sys­tem makes treat­ment so much more com­pli­cated. There is just one state-run hospi­tal for ev­ery 90,343 per­sons and 0.9 beds for ev­ery 1,000 ru­ral per­sons. The void cre­ated by sub­sidised but dys­func­tional state gov­ern­ment hos­pi­tals is be­ing filled by ef­fi­cient but of­ten ex­pen­sive pri­vate sec­tor hos­pi­tals. Af­ford­able health­care, it would seem, is be­yond the reach of most In­di­ans.

Past at­tempts to im­ple­ment large health­care schemes have been dis­mal. The Rashtriya Swasthya Bima Yo­jana (RSBY), launched by the cen­tral gov­ern­ment in 2008 with mir­ror schemes in the states, of­fered an in­sur­ance cov­er­age of Rs 30,000 for be­low poverty line fam­i­lies. A 2017 study by the aca­demic jour­nal So­cial Sci­ence and Medicine found that RSBY was in­ef­fec­tive in re­duc­ing out-of-pocket ex­pen­di­ture among the poor.

Will Modi­care meet the same fate? This is what our cover story, put to­gether by Ex­ec­u­tive Ed­i­tor Da­mayanti Datta, looks at. The scheme does mark a com­mend­able first step towards uni­ver­sal health cov­er­age. But there are is­sues. There is no clar­ity on cost. Es­ti­mates vary from Rs 10,000 crore to Rs 1 lakh crore while the pro­vi­sion in the Union bud­get is only Rs 2,000 crore for RSBY plus 1 per cent health cess. Where will the money to fi­nance this scheme come from? How will the de­serv­ing can­di­dates be iden­ti­fied? How will they pay for their in­sur­ance? Where are the re­sources, the work­force or the hos­pi­tals? What is the time­line for its ex­e­cu­tion?

A healthy pop­u­la­tion is a wealthy pop­u­la­tion. This is a fun­da­men­tal les­son for a coun­try set to be the world’s third largest econ­omy by 2030. Im­ple­ment­ing Modi­care is clearly go­ing to be the biggest chal­lenge and a per­sonal one for the prime min­is­ter since it is now fused with his name in pub­lic mem­ory. This is a chance to ei­ther leave his mark on his­tory or be re­mem­bered for not hav­ing cared. I can only wish him luck in this noble en­deav­our. He will need it.

The March 27, 2017 cover

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