[op-ed snap] Making health insurance work

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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: The government has announced an ambitious Healthcare programme in the budget 2018. The article comprehensively discusses concerns related to it.


News

 Health programme: Budget 2018

  1. It is unusual for a health programme to become the most prominent feature of a Union Budget
  2. The recommendations of the High-Level Expert Group on Universal Health Coverage (2011) resonate in the Budget of 2018
  3. The budget commits
    (1) universal health coverage,
    (2) strengthening of primary health care (especially at the sub-centre level),
    (3) linking new medical colleges to upgraded district hospitals,
    (4) provision of free drugs and diagnostics at public health facilities, and
    (5) stepping up financial protection for health care through a government-funded programme that merges Central and State health insurance schemes

The National Health Protection Scheme

  1. The scheme will provide cost coverage, up to Rs. 5 lakh annually, to a poor family for hospitalisation in an empanelled public or private hospital
  2. The precursor of the National Health Protection Scheme (NHPS), the Rashtriya Swasthya Bima Yojana (RSBY), provided limited coverage of only ₹30,000, usually for secondary care
  3. Though it improved access to health care, it did not reduce out-of-pocket expenditure (OOPE), catastrophic health expenditure or health payment-induced poverty
  4. The NHPS addresses those concerns by sharply raising the coverage cap
  5. But the NHPS too remains disconnected from primary care.

How will the scheme work?

  1. The NHPS will pay for the hospitalisation costs of its beneficiaries through ‘strategic purchasing’ from public and private hospitals
  2. In the NHPS the government will pay most of the money on behalf of the poor, unlike private insurance where an individual or an employer pays the premium
  3. Caution: Both Central and State health agencies or their intermediaries will have to develop the capacity for competent purchasing of services from a diverse group of providers
  4. Otherwise, hospitals may undertake unnecessary tests and treatments to tap the generous coverage

What is the main concern?

  1. Reduced allocation for the National Health Mission and sidelining of its urban component raise concerns about primary care
  2. If primary health services are not strong enough, there is great danger of an overloaded NHPS disproportionately draining resources from the health budget
  3. That will lead to further neglect of primary care and public hospitals, which even now are not adequately equipped to compete with corporate hospitals in the strategic purchasing arena
  4. That will lead to decay of the public sector as a care provider
  5. This must be prevented by proactively strengthening primary health services and public hospitals

Financial issues regarding the scheme

  1. The NHPS will need more than the Rs. 2,000 crore presently allocated
  2. As the scheme starts in October 2018, the funding will cover the few months before the next Budget
  3. It is expected to require Rs. 5,000-6,000 crore to get it going in the first year and Rs. 10,000-12,000 crore annually as it scales up

Responsibility of the State Government

  1. State governments have the main responsibility of health service delivery and also need to bear the major share of the public expenditure on health
  2. The National Health Policy (NHP) asks the States to raise their allocation for health to over 8% of the total State budget by 2020, requiring many States to double their health spending
    Some issues
  3. The NHPS needs a buy-in from the States, which have to contribute 40% of the funding
  4. Even with the low cost coverage of the RSBY, several States opted out. Some decided to fund their own State-specific health insurance programmes, with distinctive political branding
  5. Will they agree to merge their programmes with the NHPS, with co-branding?
  6. The NHPS requires a high level of cooperative federalism
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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