The union finance bill presented in parliament earlier this month promises a lot by way of better access and improved healthcare services for the citizens of the country. The government seems to have suddenly woken up to the broken down public healthcare system in India and wants to fix it. This is good news for the ordinary citizens of the country as well as the various stakeholders in the healthcare industry.
It also raises a few questions.
But before that, let us have a quick look at what the finance minister has promised. The finance minister has announced The National Health Protection Scheme (NHPS), which will provide an insurance cover of INR 500000 to 10 million families and is being presented as the world’s largest government-funded healthcare programme.
The government has also proposed to set up over 150000 Wellness Centres under the Ayushman Bharat Scheme. These Wellness Centres will be set up in rural areas, providing better access to the rural communities, presently deprived of any sort of healthcare altogether.
The finance minister has also announced that the government will set up 24 new medical colleges and training institutions.
On the face of it, these announcements do appear to be bold and innovative. They certainly indicate that the government is thinking big on overhauling the public healthcare system in the country. This in itself is a big step forward and should be applauded.
Let us now look at some troubling questions regarding the NHPS.
The Worrying Questions
The finance minister, while making these grandiose plans hasn’t announced the financial allocations for this scheme. The government also does not seem to know how will this program be funded. Essentially, one isn’t sure, how much money will be needed and where will it come from. Some independent experts have calculated that this will cost around INR 60000 Cr (A little over USD 9 bn). That is a lot of money to find.
Healthcare in India is a state subject and thus the scheme will have to be managed by different states and will probably be funded by contributions from the union government as well as the state governments. With the precarious state finances of most of the states, one is not sure if they will be able to find adequate funding for the program.
The logistics of the scheme appear very vague. One is not clear as to how these 10 mn families are identified. One assumes that they will hail from the economically weaker sections of the society, one isn’t sure how will the benefit really be passed on to them. Also, what isn’t clear is the exact details of the coverage that will be extended. For instance, will the insurance cover day to day out-patient expenditure, drugs or just in-patient services. These details will have to be thought through and worked out rather quickly. Not a mean task, considering the sheer scale of the scheme.
If we were to now look at the supply side of things, one obvious question is, which all hospitals, nursing homes, and clinics will be involved in the scheme. Since more than 80% of healthcare services in India are provided by the private sector, it seems they will have to play a major role in the implementation of the scheme. The government will have to initiate some kind of a dialogue with the private healthcare services providers and get them to agree to the commercial terms of the scheme. This in itself is a gargantuan task as the private healthcare sector is pretty fragmented.
Then there are questions related to the availability of sufficient beds to be able to cater to the sudden explosion of demand that is likely to happen, once the scheme is rolled out. An assessment of the supply side constraints will have to be done to ensure that there are enough beds to meet the demand. Also, a suitable mechanism will have to be evolved to control access to high-end secondary and tertiary care beds, which are in limited supply. This would probably imply developing a robust primary healthcare system, which isn’t visible as yet.
The Indian healthcare system suffers from a patchy and uneven quality of services that are delivered across the healthcare spectrum. Thus, on one hand, we have corporate hospitals, attracting overseas patients in large numbers, we also have small “mom and pop” nursing homes, registered as hospitals providing very little by way of service. In a world of free insurance coverage of INR 500000, how will the government ensure that patients do not end up only at the doors of large and better-equipped hospitals? We will also require a multi-level healthcare quality regulator, which transparently documents and publishes quality outcomes at various hospitals working under the scheme.
Finally, in a scheme this size and with the financial provisions that need to be done, the government will have to figure out a foolproof delivery mechanism to the truly deserving. In the past, we have seen that corruption and greed at all levels of bureaucracy derail such massive public spending programs. One hopes that the government will be able to work out some mechanism by which the benefits of the NHPS will percolate down to those who need it most.
The views expressed are personal