Hardly a gamechanger {Public Policy}

Context

This article presents debate on The National Health Protection Scheme announced in this year’s Budget.

Stats on target group

  • The government’s target group seems to be the bottom 40% (50 crore) of the population
  • An analysis of the National Sample Survey (NSS) 71st round (2014) unit record data for “Social Consumption in India: Health” shows that only 11.3% of the bottom 40% (10.5% covered by government insurance) population has any insurance coverage as against 17.9% for the top 60% (14.3% covered by government insurance).
  • In other words, just to bring the entire 40% of the population under health insurance is a huge task, with fiscal implications. As latest official data for 15 States show, starting from 2008, only 66% of the target below poverty line population has come under coverage of the Rashtriya Swasthya Bima Yojana (RSBY)

Issue

The problem, however, is in terms of the rate of hospitalisation and reimbursement of expenses that insurance companies pay.

Important observation

1. The rate of hospitalisation for those covered under some kind of health expenditure support is higher than those without any cover.

Solution

If the new health scheme announced in the Budget brings more people under insurance, then the rate of hospitalisation will show significant improvement.
2. Reimbursement as a percentage of medical cost of hospitalisation in government schemes is abysmally low, especially for the bottom 40% of the population.

Solution

This raises questions about the efficacy of government schemes. Even with the meagre coverage of Rs. 30,000 (RSBY), the proportion of hospitalisation cost reimbursed is low. There is no guarantee that increasing coverage will improve this.
3. the proportion of hospitalisation cost reimbursed is much higher for insurance schemes directly bought by households than government ones.

Solution

This could be a result of low premiums paid by the government or a general apathy towards honouring the insurer’s commitment when the payers are not the actual patients but the government.

Some of the highlights of the policy are

• Raising public healthcare expenditure to 2.5% of GDP from the current 1.4%.
• Providing a larger package of assured comprehensive primary healthcare through the ‘Health and Wellness Centres’, which includes care for major non-communicable diseases (NCDs), mental health, geriatric healthcare, palliative care andrehabilitative care services.
• Ensuring the availability of 2 beds per 1000 population distributed in a manner to enable access within golden hour.
• In order to provide access and financial protection, the policy proposes free drugs, free diagnostics and free emergency and essential healthcare services in all public hospitals.
• The policy also looks at reforms in the existing regulatory systems both for easing manufacturing of drugs and devices to promote “Make in India”and also for reforming medical education.

The Policy is focussing on the following targets

• Increase life expectancy at birth from 67.5 to 70 by 2025.
• Increase use of public health facilities by 50% from current levels by 2025.
• Reduce infant mortality rate to 28 by 2019.
• By 2020, reduce current use of tobacco by 15%, and 30% by 2025.
• A 40% reduction in the stunting of children under-five by 2025.
• Everyone has access to safe water and sanitation by 2020.
• To ensure that by 2025, more than 90% of new-borns are immunised by the time they turn one.
• Meet more than 90% of family planning needs by 2025.

Source: The Hindu

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