[op-ed snap] Follow the states: National Health Protection Scheme

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Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particulars of the NHPS

Mains level: Suggestions given in the newscard. And the lessons that government can learn from the Rajiv Gandhi Jeevandayi Aarogya Yojana(of Maharashtra).


News

Context

  1. National Health Protection Scheme (NHPS)

Same schemes are successfully implemented in many states

  1. National Health Protection Scheme(NHPS) is not the first public health insurance programme in the country
  2. Many states, including Maharashtra, Karnataka, Rajasthan, Andhra Pradesh, Goa and Tamil Nadu, have successfully implemented health insurance programmes, easily covering over 50 crore people

Maharashtra: Rajiv Gandhi Jeevandayi Aarogya Yojana

  1. In Maharashtra, the Congress-led government started the Rajiv Gandhi Jeevandayi Aarogya Yojana in 2012
  2. This is a universal coverage scheme that benefits 2.23 crore poor households (over 95 per cent of the state’s population)
  3. An insurance cover of Rs 1.5 lakh per year is provided to each insured family
  4. The public sector insurance company that was selected charged a premium of Rs 333 (plus taxes) per family
  5. Experience in Maharashtra suggests that the NHPS will have to consider many critical aspects
  6. The first is the total cost. There is a token provision of Rs 2,000 crore in the budget. However, the total cost is likely to be nearer Rs 20,000 crore per year
  7. A new 1 per cent cess will make about Rs 11,000 crore available to the government in a year

Selection of insurance provider for the scheme

  1. Selecting the insurance provider is an extremely complex process. Each step, such as whether private sector companies would be allowed to bid, must be considered carefully
  2. Otherwise, it could invite legal challenges

Accreditation of participating hospitals(under the scheme)

  1. The accreditation of participating hospitals is another difficult exercise
  2. The Rashtriya Swasthya Bima Yojana (RSBY) is a glaring example
  3. Many private hospitals registered under the RSBY were reported to have indulged in malpractices such as prescribing unnecessary diagnostic testing and hospitalisation

The NHPS is not enough

  1. Insurance-based intervention in the health sector can only be a partial solution
  2. The government cannot abdicate its responsibility of providing a high-quality and affordable public health infrastructure
  3. For the infrastructure, the National Health Policy has set a target of health expenditure to reach 2.5 per cent of the GDP by 2025
  4. Experience in Maharashtra has shown us that the implementation of such a large health insurance scheme requires huge preparation in the creation of infrastructure
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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