The Centre’s new health insurance scheme envisages medical coverage to 10 crore poor families, with an annual insurance ceiling up to Rs 5 lakh per family. However, experts say that implementation of the scheme will be a difficult task.

The Union Budget presented by Finance Minister Arun Jaitley on 1 February unveiled the National Health Protection Scheme (NHPS), a mega healthcare project which the government claimed was the world’s biggest healthcare scheme. The NHPS will target up to 50 crore individuals from financially vulnerable households, a demographic that accounts for almost 41.3% of the total Below Poverty Line (BPL) population. Under the NHPS, four in 10 Indians will be provided tertiary care in government and private hospitals, within the insurance cap allocated per family. Tertiary care is extended to patients who are suffering from terminal illness.

Although the government seems optimistic, experts say that the implementation of the NHPS requires a lot of ground work. In the 2016-17 Union budget, the Finance Minister had announced a similar scheme which was meant to cover health expenses up to Rs 1 lakh per family, but it is yet to be implemented.

Ramesh Kumar Ladia, a former official of the health insurance unit of New India Assurance Co Ltd, said: “Why should anyone even take NHPS seriously? In the 2016-17 Budget, the Finance Minister had announced a similar healthcare scheme which is yet to be implemented. Over a dozen states have adopted similar health schemes at much lower coverage limits compared to the NHPS, but they have an abysmal performance record.”

“Illegal payments claimed by hospitals are another issue that needs to be taken care of. Many studies have shown that most of the insured patients who used private hospitals ended up spending their own money on treatment. In state run hospitals, where treatment is supposed to be largely free, patients end up buying consumables and medicines from private pharmacies because the hospitals simply didn’t have enough supplies,” Ladia added.

‘Many studies have shown that most of the insured patients who used private hospitals ended up spending their own money on treatment.’

Commenting on the NHPS, Surender Taenja, a former Delhi state medical council official, said: “India’s private healthcare system is largely unregulated and dodgy and this leads to conflict with patients. Many believe that private facilities are indifferent towards the poor and do not even allocate 25% bed mandated for BPL families.”

“The country has an abysmal record in public healthcare. India currently spends a little over 1% of GDP on public healthcare, one of the lowest levels in the world. Due to the abysmal public spending, individual households bear the brunt of the expenditure, accounting for almost 67% of the total health spend. I think the NHPS will work more as a booster for most of the corporate insurance firms than serve any other purpose and private hospitals that get empanelled would no doubt have a market advantage over others,” Taneja said.

Nagendra Arora, development economist and professor of social work at Rajasthan University, told The Sunday Guardian: “The big question is who will treat patients as the number of doctors per lakh of population is much below requirement.”

To meet the demands of NHPS, more government medical colleges and hospitals need to be opened; however, the present scenario is poor as there are 479 medical colleges affiliated to the Medical Council of India (MCI) as opposed to 543 parliamentary constituencies and the distributions of these colleges are also not even.

Currently, the countries that provide such healthcare security based on values and their own development context include Canada, the UK, Japan, Thailand, and Sri Lanka.

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