Health

IAS Parliament 7 years

KEY POINTS

NHPS

· National Health Protection Scheme (NHPS) (Ayushman Bharat) is a proposed scheme of GoI, announced in Union Budget, 2018-19.

· It is dubbed to be the world’s largest government funded healthcare programme.

· The scheme seeks to provide health cover to 10 crore economically vulnerable families.

· Every family will be provided Rs. 5 lakhs annually for secondary and tertiary health care.

Issues in Health Insurance sector

· Insurance policies sold to individuals invariably contain a plethora of exclusions in the fine print, which diminishing their practical value.

· By its very nature, such exclusion defeats the purpose of the health policy and tilts the balance heavily in favour of the insurer firms.

· The health-care system also lacks regulation of costs.

· Also, there is an asymmetry of information, with the insured member unable to assess the real scope of the policy or negotiate the terms with the provider.

· These highlight the need for stronger regulations within the health insurance and hospital sectors in India.

Way forward

· Delhi HC’s observations in this regard, exclusions cannot be unreasonable or based on a broad parameter such as genetic disposition or heritage should have a broader effect of eliminating similar exclusions.

· The central government in line with the Delhi HC, must review all the policies, and eliminate unreasonable exclusionary clauses designed to avoid claims.

· Also, there is a necessity to define costs, curb frauds and empower patients.

· Insurance law has to be revisited to ensure that there is a guaranteed renewal of policies, and that age is no bar for entry.

· It needs to be ensured that pre-existing conditions are uniformly covered.

· State sponsored insurance that is universal in coverage (which is envisioned in the long-term) could help in addressing the problems of exclusion.

· As a short-term priority, it is important to remove discriminatory clauses in policies and expand coverage to as many people as possible.