The National Health Policy draft, a lament on the dismal state of health in India, is short on policy specifics. It provides an informed but somewhat breezy overview of numerous policy initiatives in public health, insurance coverage and trends in the private healthcare industry, only to end with an inexplicable suggestion that health is legislated into a right. How this will have any impact on such things as infant mortality rates and maternal mortality rates or make quality health accessible to all is hard to fathom. The document is virtually silent on the institutional and regulatory reforms required to increase both the coverage and quality of health care, while conceding that there is chaos all around. A society with diverse health concerns needs a spectrum of policy interventions. Increasing public investment in healthcare beyond 1 per cent of the GDP, as flagged by the draft, is necessary but not sufficient. The encouraging performance of India’s flagship low-cost health insurance scheme, the Rashtriya Swasthya Bima Yojana (RSBY), which covers a population of 370 million, tells us private infrastructure must also be placed at the disposal of the needy. This sort of protection can stem the trend of people being pushed into poverty each year because of rising health costs. Therefore, health coverage need not be funded through taxes alone. Tax-funded initiatives, by not involving stakeholders, may not yield the best results, given the sort of governance machinery we have.

If India’s health coverage drive is to ride on affordable insurance, à la Obamacare, it needs to iron out last mile implementation issues. These include smart cards not being distributed months after enrolment, rural hospitals not being equipped with the technology and hospitals not being reimbursed on time. What has also been observed is that private hospitals prescribe procedures on the basis of reimbursements they stand to get rather than on medical considerations. The TPA (third party administrator) teams up with the hospital to inflate bills and illnesses, leaving both consumers and insurance companies worse off. Maharashtra, researchers point out, is working towards a ‘medical protocol’ of procedures, with insurance companies involved in the exercise. Other States should follow suit. The regulation of nursing homes, hospitals and medical and pharmacy colleges cannot be left to the ill-equipped health departments of State governments, which are anyway focused on providing health facilities rather than monitoring them. Clearly, an independent health regulator, as in the case of pharma, is called for to regulate a dynamic but fragmented industry.

The policy framework should have delved into such nitty-gritty. It could have pointed out that governments can save on medicine procurement expenses by coordinated purchases in bulk, as Rajasthan and Tamil Nadu have done. Spending more does not secure the best results if such details are overlooked. However, in its fiscal consolidation exercise the government should spare health and target other subsidies instead — allaying apprehensions to the contrary.

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