Providing effective health cover

| | in Oped

Rather than running its own health facilities, the Government should consider providing health insurance to its citizens. There are many Government-sponsored health insurance schemes but their evolution has been slow

Rudolf Virchow, a German pathologist, public health activist and politician, said that medicine is a social science and politics is nothing else but medicine on a large scale. As we know, health is not just about diagnosing ailments, building hospitals and providing social services; it is an issue of social justice. Getting good healthcare is not a privilege; but a fundamental right. A humane society must provide basic health access to its citizens irrespective of their paying capacity.

Everyone across the world seeks healthcare, either through a Government facility or private sector or a combination of both. ‘Socialised medicine’ (state medicine) is a term used for a healthcare delivery system wherein the Government takes the responsibility to provide healthcare to its citizens at taxpayers’ cost. This is also called public-funded healthcare.

The latter can be largely delivered in two ways: One, where the Government provides healthcare by directly administering clinics, hospitals and other facilities. In modern times, Cuba is a classic example. The Communist country has only Government-run facilities and no private medical sector. The second system is the provision of healthcare through health insurance. In Canada, the Government ensures health insurance for everyone and patients can to a Government or private facility.

Over the last six decades, India has struggled to provide healthcare facilities to its people. Healthcare financing in India has been poor. Th country spends just four per cent of its Budget on healthcare. Notwithstanding its burgeoning population, vast geographical area, illiteracy rate and poverty, the Government has been able to take healthcare to the rural populace through sub-centers, primary health centers, and community health centers. At the same time, the private medical sector has also developed significantly. However, many challenges still remain.

The Union and State Governments have so far, focussed on administering their own healthcare delivery systems. Government-run dispensaries, hospitals and health programmes have delivered sub-optimal results. Public perception about Government-run hospitals is also poor. One alternative that has remained largely unexploited in India is the provision of health coverage via health insurance. The Government, rather than running its own health facilities, should consider providing health insurance to its citizens. It is time that India follows this model to allocate resources and funds to its public health programmes.

As Mr Narendra Modi took charge as the Prime Minister of India, he envisioned health insurance for everyone. His ambitious National Health Assurance Mission is yet to be launched. This will gradually develop health insurance in India. To be rolled out in phases, it may take a decade before the scheme can be offered to everyone. The National Health Assurance Mission is an example of Government-sponsored health insurance scheme.

The UPA, in 2008, launched the ambitious Rastriya Swasthya Bima Yojna. The scheme focuses on providing in-patient coverage to families living below poverty line. With a mere registration fee of Rs30, RSBY provides cashless health insurance to BPL families for up to Rs30,000. The premium is paid partly by the State Government (25 per cent) and partly by the Union Government (75 per cent). With the introduction of the NHAM, the RSBY will be gradually merged into the former.

Government-sponsored health insurance schemes are not new to India, but their evolution has been slow. For example, the Employees’ State Insurance Scheme and the Central Government Health Scheme have been in vogue for decades. Mediclaim was a private voluntary health scheme launched in 1986 by Government insurance company. In the last decade, many States have successfully launched health insurance schemes like  Aarogyasri (Andhra Pradesh), Vajpayee Arogyashree (Karnataka), the Chief Minister’s Comprehensive Health Insurance (Tamil Nadu) and RSBY Plus (Himachal Pradesh).

The most crucial advantage of Government-sponsored healthcare schemes is that they primarily target the poorer section, thus enabling a bottom up approach to health-for-all. Health insurance is not without challenges in India. First, there is already a high level of medical malpractice. The unfettered continuation of such unethical practices may bleed health insurance schemes. Second, there is lack of standardisation of medical treatment regiments and practices, which create challenges for insurance companies, when it comes to reimbursements.

Medicine cannot just continue as a private matter; it must evolve into a social institution wherein it can serve the basic needs of society. Universal health assurance will hopefully accelerate the process for India in the right direction.

(The writer practises neo-natal medicine in Chicago)

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