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.
