The NITI Aayog has recently proposed the creation of a new National Health Authority.
What is the proposal?
National Health Authority(NHA) is proposed to administer the Pradhan Mantri Jan Arogya Yojana (PMJAY) and will be chaired by the Health Minister with the Aayog as its administrative body.
It is envisioned as an autonomous body that could initially be formed by an executive order.
This is because, with health and public health being state subjects, two or more state legislatures will need to pass resolutions before Parliament enacts a law for the constitution of the NHA. (Article 252)
The NHA will report directly to the Prime Minister’s office, making the Union Health Ministry to have little say in the PMJAY scheme.
Why is there a demand for a separate authority?
PMJAY will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers' families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban.
PMJAY is currently administered by the National Health Agency which is a registered society under the Health Ministry.
While the Health Ministry is not responsible for the day to day running of the scheme, it does have a say in policy matters.
For example, the package rates were decided by the Directorate General of Health Services.
However, since PMJAY caters to around 40% of the population, setting the price for the targeted people could artificially inflate health costs for the remaining 60% who are not covered under the scheme.
Hence, there is an argument for a distinct authority, without government intervention, to administer the price modalities of the scheme.
What will be its purpose?
The NHA will address the shortage of capacity in many states at the administrative level that could manage the extra monitoring and supervision involved.
Also, NHA could lay down uniform standards and access rules that could allow free movement between different jurisdictions without losing access to health care or to health information.
Internal migration from labour-surplus areas to those parts of the country where wages are higher is raising in India and hence NHA should ensure that they are not left out.
NHA will have penal powers and can issue orders to its state counterparts rather than mere advisories and it can also act against errant hospitals.
The NHA will also have full say over the package rates and the mandate to negotiate with the private sector for the strategic purchasing of services.
The NITI Aayog proposal also envisages the formation of an advisory board.
What are the concerns?
The crucial determinants of any scheme’s success lie at the state government level.
The experience from previous centrally-sponsored schemes is that line ministries have often created too many requirements and required excessive standardisation.
These have meant that the administration of schemes is not as accountable or efficient as it would be otherwise.
This must not be repeated in the case of the NHPS.
Thus, NHA as an independent authority provides for the chance of less interference from the government.
But it should ensure that the NHPS does not turn into a purely central scheme with little involvement from the states.
