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What is the issue?
- The recent budget announced the Ayushman Bharat programme.
- It is imperative at this juncture to look into the various facets of the programme to assess its potential in health care services.
What are the shortfalls?
- Rashtriya Swasthya Bima Yojana (RSBY) was a precursor of the National Health Protection Scheme (NHPS).
- It provided limited coverage of Rs.30,000, usually for secondary care.
- The NHPS addresses the concerns in RSBY relating to:
- out-of-pocket expenditure (OOPE)
- catastrophic health expenditure
- health payment-induced poverty
- NHPS has sharply raised the health care coverage.
- However, the shortfall of not covering outpatient care in RSBY continues in NHPS as well.
- Notably, outpatient care accounts for the largest fraction of OOPE.
- They include medical procedures, surgeries, therapies, classes, diagnostic tests, etc without the need for patient's overnight stay.
- The NHPS also remains disconnected from primary health care services.
- The transformation of sub-centres to health and wellness centres under the NHPS is welcome.
- However, the reduced allocation for the existing National Health Mission and sidelining of its urban component raises concerns.
- It signals a neglect of primary health care.
Why is primary health care so significant?
- Primary health services need to be strong enough to reduce the need for advanced care.
- Less attention for primary care could lead to an overloaded NHPS.
- This in turn could disproportionately drain resources from the health budget.
- This could lead to further neglect of primary care and public hospitals.
- Notably, even now these are not adequately equipped to compete with corporate hospitals in the strategic purchasing arena.
- This shortfall in health care policy is potential of ruining the public sector as a health care provider.
What are the financial implications?
- Unlike a private insurance where an individual/employer pays the premium, in NHPS the government pays most of the money.
- A large number of people subscribe to an insurance scheme.
- However, only a small fraction of them will be hospitalised in any given year.
- Given these, the NHPS is expected to be a financially viable option.
- However, it will need more than the presently allocated Rs.2,000 crore.
- Around Rs.5,000-6,000 crore is required to sustain it in the first year and Rs.10,000-12,000 crore annually as it scales up.
- It will draw additional resources from the Health and Education Cess.
- It will also depend on funding from States to boost the Central allocation.
What will the role of States be?
- The State governments have the main responsibility of health service delivery.
- The NHPS needs a buy-in from the States, which have to contribute 40% of the funding.
- The National Health Policy (NHP) asks the States to raise their allocation for health to over 8% of the total State budget by 2020.
- The NHP proposes the centre to raise public health expenditure to 2.5% of GDP by 2025.
- The Central Budget has not signalled a movement towards this goal.
- Given this, the states taking actions on the NHP goal is highly uncertain.
- Notably, the goal requires many of the States to nearly double their health spending.
- 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.
- Given this, the states merging their programmes with the NHPS seems doubtful.
- The choice of whether to administer NHPS through a trust or an insurance company will be left to individual States.
What lies ahead?
- Primary health services and public hospitals should be proactively strengthened.
- Capacity building - The NHPS will pay for the hospitalisation costs of its beneficiaries.
- This will be done through ‘strategic purchasing’.
- It refers to allocation of pooled financial resources to public and private hospitals who are healthcare providers.
- This calls for a well-defined list of conditions including:
- adoption of standard clinical guidelines for diagnostic tests
- treatments suitable for different disorders
- setting and monitoring of cost and quality standards
- measuring health outcomes and cost-effectiveness
- Both Central and State health agencies or their intermediaries will have to develop their respective capacities.
- This is essential for competent purchasing of services from a diverse group of providers.
- Otherwise, there is a possibility for the hospitals to undertake unnecessary tests and treatments to tap the generous coverage.
- Federal - In a federal polity, an all-India alignment around the NHPS requires a high level of cooperative federalism.
- This is a prerequisite to make the scheme viable and ensure portability of coverage as people cross State borders.
Source: The Hindu