Universal Health Care from Myth to Reality

“As per latest data report of National Sample Survey Office (NSSO) on Health and Morbidity known as ‘Social Consumption on Health’ conducted during NSS 71st round (January – June 2014)… “…percentage of persons having covered under any health insurance scheme is 14.1 per cent in rural areas and 18.1 per cent in urban areas.”

According to Insurance Regulatory and Development Authority of India (IRDAI), 28.80 crore people constituting 24 percent of country’s  total population were covered under health insurance policies provided by both public sector and private sector during 2014-15 (including government sponsored schemes like RSBY).

According to data from the National Health Profile (NHP) released in April, 2018, only 27 percent Bharatiyas or approximately 35 crore people have health cover. In other words, more than 100 crore of Bharat’s population do not have any health insurance to take care of their medical needs. In 2014-15, average per capita public health expenditure in the states in Bharat ranged from Rs 940-2,532 (the expenditure being highest in north eastern states and lowest in the states like Bihar, Jharkhand, MP, Chhattisgarh, Odisha, Rajasthan, UP and Uttarakhand).

Country

Health expenditure as % of GDP Per Capita Health Expenditure in  $

Government health expenditure as % of  total health expenditure

BRICS Nations

Year 2015

Year 2015

Year 2015

Brazil

8.91

780.40

42.75

Russia

5.56

523.77

61.08

India

3.89

  63.32

25.59

Canada

10.44

4507.55

73.55

South Africa

 8.20

470.80

53.55

Ranked by GDP
USA

16.84

9535.95

50.36

China

  5.32

  425.63

59.78

Japan

10.90

3732.56

80.43 (year 2000)

Germany

11.15

4591.85

84.47

India

  3.89

    63.32

25.59

UK

  9.88

4355.81

80.35

France

11.07

4296.15

78.92

(Source: World Bank)

As can be seen from the above data, Bharat which is part of the BRICS group and ranking 5th nation in terms of GDP from the list of top 7 countries stands at the bottom when we try to compare Bharat’s performance with regard to health care expenditure in terms of percentage of GDP, per capita health expenditure in $, Government health expenditure as percentage of total health expenditure.

Bharat has 15 national health programmes (disease control and promotive programmes) and some of these health programmes have varying levels of ‘integration’ with the National Health Mission (NHM) addressing point-of-entry primary healthcare delivery. While the 12th Five Year Plan advocated the integration of national health programmes, it did not specify the scope and nature of integration between programmes.

Ayushman Bharat

Ayushman Bharat is National Health Protection Scheme, formally to be launched on 25th September, 2018 will cover over 10 crore poor families (approximately 50 crore beneficiaries). It will provide coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization. Ayushman Bharat – National Health Protection Mission will subsume the on-going centrally sponsored schemes – Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Funding of the Ayushman Bharat will be shared in the ratio of 60:40 by the centre and the states respectively. However, the North Eastern states, Himachal Pradesh, Uttarakhand and J&K, will have a 90:10 funding ratio as they fall under the special category states. Each state will need to create an apex body that will implement and monitor the scheme. The Centre’s funding will be to this apex body proposed to be set up by the states. So far 20 states have indicted their willingness to take part in this Ayushman Bharat scheme. The premium to be paid to the insurance companies under this scheme is estimated to be more than Rs.12,000 crores on annual basis. This scheme is expected to cover around 36% of the total country’s population.

Though the intention behind the launching of Ayushman Bharat is to address the secondary and tertiary health care needs of the people there is a need to critically evaluate the outcomes of the various existing health schemes and bring all the schemes-viz., primary, secondary and tertiary health care schemes, under one umbrella. Also, all the states should be encouraged to join under this single umbrella so that every citizen of the country is covered under this comprehensive health insurance scheme (CHIS). Premium amount will substantially reduce when the total population of the country is covered under this CHIS. The centre in consultation with the states and the health insurance companies may design the modalities of fixing the amounts of premium and the medical cover for the total population of the country under this CHIS in a uniform manner. In turn, the government may bear the burden of the total premium for the people below the poverty line (BPL) and decide the premium subsidy to be given to the people who are above BPL and middle class depending on certain income criteria.

The government may also incentivize upper middle class and rich people by a nominal part funding of the premium and make this health insurance cover as mandatory for all the citizens of the country. Employers in the private sector to be mandated to extend this CHIS to their employees. Government may extend premium subsidy to the employers in MSME sector.

This CHIS should subsume all other existing medial health insurance schemes in the country. Master health check up to be made compulsory for the yearly renewal of this mandatory CHIS. Such a provision will result in early diagnosis of diseases and reduction in the incidence of curative health treatment which is also very expensive. Under this CHIS people may be given the option of selecting the hospital of their choice (i.e., government or private hospital) as well as the type of treatment (i.e, allopathy or alternative medical treatment) and cashless medical treatment to be encouraged which will give a boost to digital/ cashless payments culture in health care sector. All the states should have a state health regulatory authority which in turn will be under the overall supervision and control of an apex health regulatory authority at the centre.

In 2015, The Institute of Cost Accountants of India has prepared a Guidance Note on Cost Management in Health Care Sector recommending methodology for costing of healthcare services, setting bench marks and designing templates for several medical procedures. In line with this guidance note, the health regulators may fix the pricing of healthcare services and design operational and control mechanisms to monitor the pricing being levied by the hospitals. An integrated citizens’ medical history data base to be developed in a highly secured web portal giving access to the doctors, hospitals, diagnostic centres and pharmacies in digital format.

Using tools like big data and analytics the government can take prompt proactive measures to improve the quality of health care services by effective monitoring of this web portal. Appropriate legislative measures are needed to protect the right to privacy of the people in the health care sector and at the same time ensure freedom to the government to use this web portal for macro level policy making and take the required steps in preventive healthcare.

While the financial burden to the government may increase under this proposed CHIS, by scaling up the health insurance scheme to cover the total population of the country there will be significant reduction in the health insurance premium per head. The incidence of expensive curative health care can be reduced substantially since there will be greater focus on preventive health care by making yearly master health check up mandatory under this CHIS.

Let us hope that the centre and the states will collectively work on this mechanism to launch comprehensive health insurance scheme covering primary, secondary and tertiary health care with a greater emphasis on preventive health care for every citizen of the country in the near future.

(Featured Image Source)


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About the Author

B.N.V. Parthasarathi
Ex Senior Banker, Management and Financial Consultant, Visiting faculty at premier B Schools and Universities. E mail- [email protected]