Seldom do we approach the World Health Day in India with any sense of optimism for the health sector. Such has been the abysmal record of successive governments on healthcare. A particularly disappointing year was 2017, punctuated as it was by reports of infant deaths in a public hospital in Gorakhpur and of evidence of malpractice and overcharging by top private hospitals.

The cynic that lurks in us cannot be faulted for reaching for a fistful of salt on hearing the customary promises made on the World Health Day (April 7).

The big-ticket promise of a National Health Protection Scheme (NHPS), euphemistically termed ‘Modicare’ by critics and supporters alike and officially as ‘Ayushman Bharat’, signals the Government's intention. Even the mere announcement of a grand scheme is good news for many. The programme involves an insurance scheme for those seeking hospital care, which would provide coverage of up to ₹5 lakh to 10 crore families. The sense of disbelief among people who follow the health sector merits some examination.

An oft-heard refrain is “we have heard it all before!” A similar promise was made in 2016, albeit with much less fanfare, to cover a similar population as envisaged under the NHPS with a ₹1 lakh annual limit. The five-fold increase in the upper limit is actually not very significant as most claims are settled at a level below ₹1 lakh.

Nothing has really changed in the past two years: The scheme distributed a paltry ₹456 crore in 2016-17 and allocated just ₹1,000 crore in 2017-18. These numbers pale into insignificance when compared to the ₹10,000- crore per year projected by the government and a perhaps more realistic figure of ₹20,000 crore to ₹50,000 crore projected by the insurance industry and public health practitioners. Will the naysayers be proved wrong this time?

It would be prudent, however, to recall that public funded health insurance schemes have been around for more than a decade in India, since the launch of the Congress Government’s Arogyashri scheme in the then Andhra Pradesh, and similar schemes now extend to many States and also includes a national scheme.

While claimed to cover a third of the country’s population, latest surveys still find that coverage (not disbursal of benefits) stands at 11-12 per cent of the population. We don’t have evidence either way to even start making an educated guess if this time it would be different.

Will the NHPS, if rolled out adequately, lead to access to comprehensive healthcare services for those who need them the most? Actually the scheme is not designed to do so. It seeks to cover a package of hospital care packages. In reality hospital care, though financially the most catastrophic for families in the immediate sense, consumes a fraction of out-of-pocket expenses on healthcare.

A much larger burden is posed by illnesses that do not require hospitalisation or are not covered by the insurance package. A study of Arogyashri claimed that the scheme covered only 4 per cent of illnesses and yet consumed a quarter of the State’s health budget.

Will a mega insurance scheme revive the moribund public system? Actually, going by experience, insurance schemes are designed to do the contrary as they essentially involve outsourcing of hospital care to the private sector. For the latter a ₹10,000 plus payout is a bonanza but it comes at a cost.

The public system gets further squeezed while the natural proclivity of an unregulated private sector towards ethical malpractices and over charging comes into play. A functioning public sector is a national asset, a burgeoning private hospital sector may well be a national calamity, as tragically proven by the peccadilloes of the likes of Fortis and Max.

Most critics of the NHPS will be happy to be proved wrong. So two cheers for NHPS as of now, and may the critics be proved wrong by World Health Day 2019.

The writer is National Convenor, Jan Swasthya Abhiyan. Views expressed are personal.

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