A game-changer or a sop

A boon for the poor and downtrodden
Harish Khurana

On February 1, Union finance minister Arun Jaitley announced a big scheme for the health sector in his Budget speech. He said the government would implement a national health protection scheme targeted at 10 crore poor and vulnerable families (50 crore beneficiaries). It will offer reimbursement of up to Rs 5 lakhs per family per year for secondary and tertiary care hospitalisation. This accounts for nearly 40 per cent of India’s population, making it the world’s largest government-funded health programme.  

The finance minister said the programme would take public healthcare in the world’s largest democracy “to a new aspiration level”, adding that his government was steadily but surely progressing towards a goal of “universal health coverage”. “This will be the world’s largest government-funded healthcare programme,” Prime Minister Narendra Modi said in his address soon after the Budget speech. The government will also establish 1.5 lakh health and wellness centres under the Ayushman Bharat programme. “We are all aware that lakhs of families in our country have to borrow or sell assets to receive indoor treatment in hospitals. The government is seriously concerned about such impoverishment of poor and vulnerable families.” These measures, Mr Jaitley believes, will be crucial to building an efficient and productive new India, and would create additional jobs, especially for women. He further stated that schemes such as Pradhan Mantri Jeevan Jyoti Bima Yojana and Pradhan Mantri Suraksha Bima Yojana will now expand to cover the lower strata of society.

Apart from the above, Mr Jaitley announced that a sum of Rs 600 crores will be provided for nutritional support to tuberculosis patients at a rate of Rs 500 per month. Additionally, 24 new government medical colleges and hospitals will be set up by upgrading existing district hospitals, thus moving towards achieving universal healthcare.

It is a hard fact that the health sector in our country has always been a neglected area. India’s public spending on healthcare has been dismal, accounting for just 1.13 per cent of GDP in 2014-15, according to the National Health Accounts Estimates report released in October 2017. This is far below what countries such as China and the US spend, and even less than the global average.

While countries like France heavily subsidise healthcare for the poor, India’s existing Rashtriya Swasthya Bima Yojana scheme, implemented in 2008, only offers low-income Indians hospitalisation coverage of up to Rs 30,000 per year.

As a result, many Indians have been forced to rely on their own funds: Out-of-pocket expenditure accounts for nearly 63 per cent of the country’s total health expenditure, and both urban and rural patients have struggled to pay for the care they deserve. “We are all aware that lakhs of families in our country have to borrow or sell assets to receive indoor treatment in hospitals,” Mr Jaitley said in his speech.

The Opposition is in a state of shock. They are worried that these type of welfare schemes for the poor will further increase the popularity of Mr Modi. So some leaders are trying to oppose it by raising the questions like where this money will comes from.

I am not able to understand their objection as we require around Rs 12,000 crores to fund this. For this, the finance minister has allocated Rs 2,000 crores and one per cent cess which is expected to raise around Rs 11,000 crore. I think this scheme is a revolutionary step in the health sector and it will will surely be a game-changer.

The writer is a Delhi BJP spokesperson

Announced with an eye on 2019 polls
Abhishek Dutt

Prime Minister Narendra Modi-led government at the Centre has broken multiple norms in his tenure, including deglamourising the Budget exercise. His governance has consistently announced reforms across the year. Another consistent characteristic of this tenure has been the perpetual struggle to implement these reforms. With a battery of technocrats at his disposal, it is rather disappointing to observe a great leader not having adequate resources to walk the talk.

Let’s leave the implementation woes for another day; the past one week has been the one of reading between the lines for accountants and economists. The health budget saw 11 per cent increase in allocation, at 1.4 per cent, a far cry from espoused 2.5 per cent. The National Health Protection Scheme, gives rise to hope and also casts aspersions. Hope for 10 crore Indians who believe their family will be covered by Rs 5 lakh health insurance every year and aspersions by those who have a list of questions, including those on the novelty of this scheme!

The scheme is not a first-of-its-kind. Before 2014, it existed in the form of Rashtriya Swasthya Bima Yojana and had an allocation of Rs 30,000 per family. In 2016, the government revised this amount to Rs 1.5 lakh. However, why the scheme remained dormant is anybody’s guess.

This may be because most states already have their own health insurance policies, that, taken together, provide cover to around 40 crore citizens. This means that the government is already an enabler in providing healthcare at the state level. Unfortunately, it is due to the abysmal failure of these schemes, and not lack of them, that we are afflicted with such poor healthcare. Doesn’t it make sense to continue with existing policies, and strengthen them than to introduce fresh schemes? On second thoughts, did they abdicate from the responsibility of enabling healthcare for past four years so that a mega reform could be announced just before the 2019 General Elections? It would augur well to fix the existing system and provide resources to achieve efficiency by using the Rs 2,000 crores as an icing over the already existing state schemes. An ongoing issue in the realm of public healthcare that stands unaddressed is the crippling healthcare centres at district and ward levels. Anyone who has been to a public healthcare center would agree that availability of drugs and an efficient infrastructure is a huge problem which drives the poor to private healthcare centres where they are fleeced off their savings.

The fact that households spent four times less in government hospitals as compared to private hospitals speaks volumes about the inefficiency that has settled in the sector. The insurance would be applicable on hospitalisation, which is in contradiction with the fact that around 62 per cent of spending is out of pocket.

Providing an insurance cover will hardly help address this issue. Most illnesses aggravate when not seized at their conception stage.

Prevention should be the state’s priority and cure its last resort. Insured patients will obviously be offered higher prices for admission and treatment but quality of healthcare to these patients yet remains an uncertain territory.

Another trend that caught up hours after the announcement of this scheme was its name. While the Budget documents call it National Health Protection Scheme under the title Ayushman Bharat, the BJP leaders have been calling it NaMo Care. Proof of the pudding is in the eating and proof a scheme is in its ability to be implemented.

The writer is the  Congress leader in the South Delhi Municipal Corporation