Earlier this week, a fire at an Employees’ State Insurance Corporation (ESIC) Hospital in suburban Mumbai resulted in the death of over 10 people. And investigations are under way on what sparked the fire.

But as the year comes to an end, the chilling incident reflects, in a sense, what ails healthcare across the country. Especially since the ESI is often credited by health experts as a good model that should have been replicated. It was the predecessor of many mass health coverage programmes, including Ayushman Bharat.

But in recent times, it traces the familiar downward spiral of neglect often witnessed in healthcare institutions.

The ESIC sits on ₹50,000 crore, including a free reserve of ₹30,000 crore, says independent health researcher, Dr Ravi Duggal. “Only ₹7,000 crore is used for medical care,” he says, adding that occupancy rates are low at 30 per cent, vacancies remain and some of the services are outsourced.

“Every year, about ₹16,000 crore comes in,” he says, adding this is money from workers.

Unlike health insurance schemes, the ESI model is a social security system with unlimited coverage for illnesses. And those who are on it for five years are eligible for life-long health coverage for self and spouse, on a nominal payment, he says.

Instead of fixing its gaps and strengthening it, Duggal says, the Government is thinking of getting private insurance on board. This means that private players get their hands on the corpus meant for workers.

Calling for better governance of hospitals, Indranil Mukhopadhyay, a health economist and Assistant Professor, OP Jindal University, stresses that incidents like the ESIC fire could have been averted if the Clinical Establishments (Registration and Regulation) Act, 2010, had been implemented.

In 2011, over 90 people died following a fire at Kolkata’s AMRI Hospital.

Safety and quality standards of a hospital tend to slip between the cracks of rules and implementation, he points out.

Health agenda

Nevertheless, 2018 has witnessed “health” increasingly feature on the radar of political parties. And though the programmes may be flawed, experts are hopeful that it’s a start to more meaningful conversations next year.

The Ayushman Bharat scheme, for example, has drawbacks in terms of being insurance-based and inadequately funded. If the shortcomings are not addressed, it will become a problem rather than a game changer, says Mukhopadhyay.

Other troublesome issues involving fixed-dose combination medicines, stent pricing and rules for medical devices, etc, are getting addressed. But the areas that need follow-up action on promises made by the Government are strengthening of health and wellness centres as a primary screening level and the supply of free medicines, he points out.

Promises to keep

Echoing the sentiments of earlier Governments, this one too has promised an increased health spend of 2.5 per cent of GDP by 2025. But Government-funded health systems are losing momentum, even though the Centre says it has given funds to the State to run the show.

“In the present situation, we need Centre and State governments to spend more on health, with the Centre leading the way,” says Mukhopadhyay. Besides, Governments coming into power should not dismantle existing systems that worked and instead build on them, he says, adding, “otherwise we step back on the gains we made earlier.”

As hospitals increasingly see foreign investors, Mukhopadhyay cautions the Government to keep a watch on prices. Batting for price control, he says the prices for medical services need to be universal across the country, whether a patient is under Ayushman Bharat, CGHS or ESIC schemes. “The middle class is being hit badly from both sides,” he says, as they remain a blindspot on schemes targeted at the lower economic strata. And health insurance is expensive, inadequate, or fails to kick in when needed.

The hope is that 2019 sees some political might put behind the supply of free medicines through Government hospitals, strengthening of health and wellness centres and implementation of a more inclusive universal health scheme, he says — healthy suggestions that political parties would do well to tune into, especially in an election year.

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