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NHPS: grandiose scheme, no plan

A flagship scheme announced in the Union Budget to provide easy and affordable access to healthcare for a large number of poor and needy people has been widely welcomed. The National Health Protection Scheme (NHPS), called Ayushman Bharat, which seeks to provide an insurance cover of up to Rs 5 lakh per family for secondary and tertiary hospitalisation for 10 crore families, is a much-needed plan in a country where healthcare costs have become the heaviest and most debilitating financial burden on the poor. With an estimated 50 crore beneficiaries, the scheme is touted as the largest public healthcare programme in the world. The heavy political content in the proposal, made when important elections are in sight, is clear. That might account for the many claims made about the proposed scheme. But there are serious issues that need to be clarified and resolved in the design of the scheme and its implementation.

The budget has made a provision of only Rs 2,000 crore, that too under another existing health insurance scheme, while there are different versions even from the government on the cost of the NHPS. One official put it at Rs 30,000 crore, while another pegged it at Rs 11,000 core. An independent study by a Delhi-based economic think-tank has put it at Rs 1 lakh crore a year. In any case, the financial challenge is big and it is not yet clear how it will be met when the overall fiscal situation is precarious. Without a clear idea about the financials, insurance companies may not come forward to support the scheme because they are run on actuarial principles. The large numbers may bring down the costs, but they need to be worked out and suit the insurers' business plans. Pressed for details, the Centre said that the states will bear 40% of the costs, without prior consultations with them. All states may not agree as some of them have their own schemes. The day after the budget announcement, the Karnataka government fleshed out some details of a similar scheme it had announced earlier.

There are many questions that need answers. Will the government pay the premium to insurance companies or pay the cost of treatment to hospitals? Will it cover only the treatment or take care of out-of-pocket expenses that form 70% of the costs? Given the shortage of doctors, paramedical staff and infrastructure, can the system cope with the demands of the scheme? Without clear answers to these questions and a proper implementation strategy, the NHPS will remain only one more grandiose, populist announcement before the polls. After all, that was the fate of the scheme announced in the FY2017 budget that proposed a more modest Rs 1 lakh cover for families.

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