What is the issue?
- The government has launched the ‘National Health Protection Scheme’ (NHPS), which is envisions a massive coverage of 50 crore people.
- But previous experience shows us that merely constituting an insurance scheme will do little to enhance health care.
How have previous insurance schemes fared in India?
- Design - Any public health insurance scheme would logically enhance medi-care affordability for the masses, which will consequently enhance demand.
- But as Indian public health infrastructure is still in shambles, the supply would have to be met through expansion of private health infrastructure.
- Previously - Public insurance schemes like Centre’s ‘Rashtriya Swasthya Bima Yojana’ (RSBY), and Andhra Pradesh’s Aarogyasri had been in operation.
- Both RSBY and Aarogyasri were cashless hospitalisation schemes, but they benfitited few and failed to reach the most vulnerable sections.
- Notably, outpatient care, which accounts for the most of the out-of-pocket spending, wasn’t covered under the scheme.
- Challenges - While both targeted people living below the poverty line, over-reliance on private hospitals and poor monitoring watered down their impact.
- This was because, private infrastructure tends to be concentrated in more prosperous regions (increased distances make accessibility tough).
- Some hospitals were found to have performed unnecessary medical procedures on patients, to derive monetary benefits from the schemes.
- Notably, such nefarious designs damages the health parameters and also increases out-of-pocket expenditure (in travel and other accessories).
- The lack of sureity of reimbursements has also resulted in some hospitals charging money from the patients despite the insurance cover.
What needs to be done?
- Considering the poor success of the previous schemes, some have even argued that mere demand oriented interventions by the government are futile.
- Unless the public health systems can compete with the private for funds from insurance scheme, quality healthcare will continue to elude the vulnerable.
- Also, it is important to develop monitoring systems to ensure that private hospitals registered under the scheme comply with the norms prescribed.
- Streamlining reimbursements to hospitals and efforts the expansion of both private and public health facilities at newer geographies are needed.
- Hence, while the NHPS looks massive in terms of coverage, it needs to comprehensively take these factors into account to be successful.
Source: The Hindu
