The Indian Express article Is India ready for NHPS? published on February 13, 2018, talks about the recently announced National Health Protection Scheme, or NHPS, and expresses doubts about India readiness for it. The article is written by K. Sujatha Rao, former Union Health Secretary.
The article talks about the gap between policy intention and actual fund allocation. Further, it questions the insurance-based model to redress the problem of unequal access to health. But while questioning how the costs are going to be met, the article appears to turn on itself since it also pushes arguments and observations that, in fact, make the case for health insurance stronger.
Missing the Point
Questioning a state initiative cannot be faulted on principle but media outlets and commentators appear to be criticising Budget 2018’s announcements on healthcare and the health programme for the sake of criticism.
The piece cites the Burden of Disease Report 2016, wherein disparities in health standards among different states is shown. The piece itself talks about some evidence pertaining to RSBY, which shows that 25% of people who availed services were impoverished by having to meet the indirect costs of hospitalisation. The poor, as we know, incur a high out-of-pocket expenditure on healthcare.
This itself proves that the Rs 30,000 cover per family under RSBY was not sufficient and in tune with current medical costs, if private infrastructure is utilised.
What then is the immediate solution to a high out-of-pocket expenditure for the poor? The answer seems to be insurance — a fairly big health insurance cover. And that is just what the government is aiming to provide via the NHPS.
How NHPS Trumps the Rest
The Indian Express article makes a comparison between NHPS and other insurance programmes offered by other state governments. However, such comparisons between the NHPS and various state schemes are based on a flawed premise.
First of all, NHPS is going to provide Rs 5 lakh per family, per year. Therefore, it is the biggest health insurance cover yet — more than what any of the state governments are providing at present. In contrast, the coverage under RSBY as well as Kerala’s CHIS has amounted to only Rs 30,000 per family.
Second, NHPS is going to use SECC data for identifying beneficiaries. The use of SECC data is a much better and more accurate method of enumerating the poor as it does not use household income as a parameter, but exclusionary factors (for example, motorised vehicle) and inclusion criteria, such as households without shelter, manual scavengers, etc among others to count who would make it. In contrast, the RSBY as well as state schemes like CHIS have been suing BPL data to enumerate the poor which is a dated method and suffers from being absolute, as in who benefits and who does not is determined by one strict line and often leaves out families who ought to be included. The BPL data used by such schemes has been seen to skew the figures for the targeted population which genuinely deserves to be served by the health insurance programme.
(The two above points can be read about in more detail in our earlier article: Centre Vs States? A Fact-Check on State Health Insurances and the New NHPS.)
Finally, moving to the question of lack of primary healthcare and public infrastructure, we know that with the allocation of Rs 1,200 crore, 1.5 lakh health centres will come up across India. These will provide healthcare facilities for non-communicable diseases and maternal and child health services, which includes free essential drugs and diagnostic services. Also, 24 new government medical colleges and hospitals are going to be set up, with at least 1 medical college for every 3 parliamentary constituencies and at least 1 government medical college in each state.
Do these above provisions not cater to, provide for and contribute to primary healthcare and public infrastructure?
Need and Policy Intervention
Policies are not made in a vacuum. There is a need felt by the state and it addresses the same through a policy intervention. If most of the population is dependent on expensive private services, the government may then need to come to the aid of the poor and take care of their health expenses. And that is what the Centre is doing by NHPS and health insurance, in this sense, is an immediate solution. Even if the number of poor availing private infrastructure is small in any particular case, the state will still need to provide coverage for them. And it is to be remembered that if they use public infrastructure, then it is free.
Additionally, most public infrastructure, new and old, including the 1.5 lakh new health and wellness centres, are already providing/ will be providing free healthcare services. Therefore, health insurance is an additional means to directly and immediately benefit the poor and address their healthcare requirements. New public infrastructure is being built, but it cannot be completed overnight. It is a long-term solution.
In sum, between the infrastructure to be created for healthcare, as per Ayushman Bharat, and the insurance cover to be provided by NHPS, it appears that both the immediate and long-term needs of the poor – and even the middle class – are being addressed. Whether India is ready for it or not is perhaps beside the point. India certainly needs the NHPS and the government has perhaps conceived it on the largest scale possible.
For further details about NHPS and whether it is necessary or not, please read our earlier articles: