[op-ed snap] Holes in the scheme


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

From UPSC perspective, the following things are important:

Prelims level: National Health Protection Scheme (NHPS)

Mains level: Various issues associated with the implementation of NHPS


Launch of NHPS

  1. The Model Tender Document For The Selection of Implementing Agencies For the National Health Protection Scheme (NHPS), released by the Union Ministry of Health and Family Welfare tries to address various concerns related to NHPS
  2. The document states that nearly 47 percent of the packages under the NHPS, including those related to heart ailments and cancer, require pre-authorisation
  3. This means hospitals impanelled under the scheme cannot perform these procedures until they have an authorization letter from the NHPS’s Implementation Support Agency

Why this system of checks?

  1. Current scheme’s predecessor, the Rashtriya Swasthya Bima Yojana, was riddled with unethical practices such as unnecessary hospitalization, needless investigations and billing for superfluous and unrelated treatment packages

Associated Concerns 

  1. Hospitals might shift the onus of obtaining the authorization letter on the critically-ill or their families
  2. Several procedures, including emergency consultation for acute colic, nebulization for an asthma attack, hypoglycemia in a diabetic and treatment of “dengue without complication”, will be covered by the scheme only if the treatment is availed in a government hospital
  3. Without timely treatment, a dengue fever can aggravate to a life-threatening disease

Way forward

  1. Checks on the impanelled hospitals are well in order under NHPS
  2. It would prevent private hospitals to milk the NHPS by prescribing unnecessary investigations
  3. But it should also be ensured that these checks do not come in between providing emergency care to critically ill patients or put an extra burden on their families
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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