The NDA government at the Centre had mentioned of universal health assurance in their election manifesto, meaning “No Indian will ever have to pay anything for accessing healthcare.” The Union budget has provided a prospect of examining whether this is realised.
As per the budget, the government will purchase the healthcare services for people below poverty line. According to the rough estimations, the total budget for purchasing the insurance by the government might cost around Rs 24,000 crore over the next five years.
Undeniably, a lion’s share of this money goes to health insurance and hospitals. If adjusted for each year, this is nearly equal to 13% of the total budgeted annual outlay for planned activities in health ministry in 2016-17.
What has changed now? The reasons for people getting sicker will remain the same. Efforts to screen people before they get sick and early treatment for treating sickness will also remain the same. But if one falls very sick and if that fits the diagnoses deemed suitable by insurance companies, then the proposed insurance can provide money to the hospitals to treat.
Policymakers propose that health insurance funds can be more capable of delivering proactive care compared to the government facilities, leads to better care coordination and greater reduction in diseases. The governments have the prerogative to promote health insurance. However, evidence from all over the world suggests that this may lead to unnecessary referral to private hospitals.
Speculating that insurance route will address health problems is a result of policy void with a narrow focus, leading only to benefit the fund houses. This will not assist the millions of Indians who cannot buy private health insurance and even if the government pays for it, end up selling assets or making loans due to financial catastrophe induced by illnesses.
The current move can have a disastrous impact on the equity and efficiency of the health care system. Those who pay taxes will continue to pay more of it and may have to bear the future exponential rise in voracious medical expenditure of the nation.
Instead of promoting high quality healthcare at affordable prices, the government seems to have taken the easy route of promoting insurance. Without controlling the costs and in the absence of efforts to improve primary healthcare service and access, the public resources are only going to drain filling the coffers of the insurance companies and few select hospitals.
In other words; when it is late to cure, the current proposition advises to endure; by supporting families with Rs 1 lakh if a catastrophic illness occurs. Public health proponents don’t actually oppose the move of supporting families for catastrophic health expenditure.
Instead, the demand is to focus on mostly abandoned question: why wait till it is late? Why cannot prevent the illness, wherever possible, earlier enough? Instead of enduring and pay premium for everyone, all the time, why cannot explore other available options?
There are plentiful effective interventions in promoting preventive efforts, primary health care services, and timely referrals. These require lesser investments compared to the load of insurance premium and have greater and long lasting benefits like addressing health awareness, social determinants, cultural barriers, and enhancing access to all citizens for cashless primary healthcare services.
When you fall sick, to recover you need to go through so many stages — you pay to meet a doctor, pay for secondary doctor, pay for lab report, you have a prescription, and then you buy medicines and then you recover. The net result is that the Indian private healthcare segment is estimated to reach a level of US$ 125 billion by 2017 with an overwhelming 20% compounded annual growth rate. Where does this kind of money come from?
Apart from paying taxes diligently, the common man should now pay for the premium for self, family and all the population who fall below the poverty line. At 12% of total health budget now, sooner or later will become a colossal proportion. Is there an alternative? Yes, for every rupee spent on curative services, the preventive options cost only fewer paisa.
But, the primary healthcare efforts are less extravagant; they don’t necessarily result in construction of mammoth buildings and don’t involve big sche-me announcements. Also, insurers or corporates may consider these efforts as trivial. From universal health assurance, the move has now turned towards a universal health insurance.
The policymakers have an opportunity to recognise the adve-rse consequences and make essential changes. Else, it might lead to infirmity of common man, destined to suffer otherwise.
(The writer is Additional Professor, Indian Institute of Public Health, PHFI, Bengaluru)