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Will ‘Modicare’ improve healthcare woes in India??

Government of India is likely to undertake one of the worlds largest health protection scheme in this financial year. Finance Minister, Mr Arun Jaitley had in its budget speech announced  the launch of flagship National Health Protection Scheme (NHPS) intended to cover 10 crore poor and vulnerable families and 50 crore beneficiaries. Under the scheme, 10 crore families will be provided Rs 5 lakh cover per family annually for treatment. 

Even after so many years of independence, most part of the rural India and some portion of urban India does not have access to any form of employer-provided or state-funded insurance. Our country’s  poverty burden results from out-of-pocket health expenditure, which also deters the poor from seeking treatment. A flawed healthcare system makes treatment so much more complicated. The space created by subsidized but impaired 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 not received thunderous response. 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. But with announcement of this new scheme people in India will get higher insurance coverage with low premiums. 

The Centre hopes that it will pay up to 60% of the total costs and the states can spend the remaining 40%. The government believes that several states can subsume their current health schemes and this scheme will then become more cost-efficient. However we have to wait for final details of the scheme, whether government plans to cover people at one go or, will it be in a phase wise manner. Media reports suggests that, government will spend anywhere between Rs 10,000-12,000 crore in the scheme, but final details are yet to come out. 

From the insurance companies perspective, would want to underwrite health policies only if they are priced realistically. The cost could differ, depending on the quality of hospital infrastructure, competition and governance in each state. Strengthening primary and secondary care will reduce the burden. 

The other problem which could be faced (NHPS) is that several states like Tamil Nadu, Andhra Pradesh, Kerala, Madhya Pradesh, Telangana, Chhattisgarh and Rajasthan already have their own health insurance schemes. Many other states provide health insurance to below poverty line families through the RSBY, while some states currently do not provide any public health insurance. States that already provide public health insurance will have to figure out how to integrate the NHPS with the existing schemes.

A prosperous public health system will modify state governments bargaining position to buy services from the private sector. But it would be irresponsible not to leverage capacities created in the private sector like technology and data must be used, even research and development should be encouraged. However the real challenge lies in the availability of health infrastructure such as hospital beds, doctors (mostly specialists), healthcare staff, diagnostic facilities and other things. Equally important is the administration of hospitals. There are many other gaps to be filled before we finally witness a successful health program in India.

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