Budget 2015 was catastrophic for health, as investments tanked to a historic low. Against that backdrop, when the Finance Minister talks about measures to tackle catastrophic health events, there’s bound to be some scepticism.

And that deepens on hearing the plan for a ₹ 1 lakh insurance to address catastrophes. Yes, impoverishment due to out-of-pocket expenditure on health is a major issue. But insurance can’t be the answer to impoverishment of 55 million people. Around 34 million are impoverished because they purchase medicines from the market and for a large majority, it is the outpatient care that causes impoverishment. Insurance, which caters to inpatient care, constitutes but a small part of health spending.

Further, the proposed investment of ₹1,500 crore is clearly inadequate. There are about 11 crore families in India below the poverty line. The average premium under the earlier RSBY scheme was about ₹ 400-450, including administrative expenses. And the total amount required to provide an insurance cover up to ₹30,000 (under RSBY) was ₹ 5,000-5,500 crore. If the coverage has to increase to ₹1 lakh, the premium has to also increase. Even if the premium doubles to ₹900 per family, around ₹10,000crore would be required. Against this requirement, only ₹1,500crore has been allocated, which is only 15 per cent of the required amount.

There is much evidence to show that insurance schemes in India fail to protect from out-of-pocket expenditure. The Prime Minister has been promising to provide free medicines and diagnostics for last two years since taking office.

But what emerges is an expansion of Jan Aushadhi (JA) stores to sell cheaper generic medicines. The impact of JA has remained limited, because who prescribes generic medicines for patients? Previous researches show that in many states even the public sector doctors are not willing to write generic medicines. Given the extent of irrational prescriptions — purchasing generic medicines when a prescription lists a branded drug is too much to expect from a consumer.

JA can no way substitute a Tamil Nadu model where standard quality medicines are procured cheap, effectively delivered to public facilities, prescribed by doctors by their generic (chemical) names and distributed free of cost to patients. The advantage of reaching your nadir is you can’t be pushed further down. And so is the case of the Budget on healthcare spending. If Budget 2015-16 saw the worst in the last three decades, it is natural that this would appear to improve in this Budget.

In the past few years, the government’s spending on health has been virtually stagnant. Every year, a fraction of the Budget allocation gets spent in actual terms.

There is no doubt that public spending on health has to improve in order to address the catastrophic effects of health care payment. But mere tinkering with insurance programmes will not suffice. A resilient health system needs to be built on the grounds of equity, quality and universality. States like Tamil Nadu have demonstrated that it is possible to do.

(The writer is a researcher at the Public Health Foundation of India. The views expressed are personal.)

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