Budget 2018: National Health Protection Scheme - A smart
move towards Universal Health Coverage
In an earlier
article on five strategies to wake up the moribund Indian Public Healthcare
system 1, 4, the first strategy recommended by yours truly was to
“declare health as a fundamental right and to provide universal
Healthcare”. The excerpts are as
follows:
First Strategic Intervention
– Comments And Suggestion Of The Author: 1
India
is today a $2.3 trillion economy and growing, it is the right time for the
government to go big, allocate 3 per cent or more of GDP for health, “declare
health as a fundamental right” and provide – Universal Health Coverage (UHC).
It is time to take charge and go for big audacious goals. Strong governments
can pull through the impossible and achieve results beyond the bounds of human
imagination due to collective efforts and the goodwill of people. This is
actually Modi’s moment in history to seize and leave an indelible mark, more
importantly; it is the right thing to do 1.
UHC,
in its simplest definition means, access to quality, effective and affordable
health services for all, without imposing financial burden. This can be achieved through various methods using government and
private sector expertise and the costs borne by insurance premium paid by the
government on behalf of citizens and other methods feasible. All citizens
should be entitled to a comprehensive package of healthcare services, and have
access to public health and accredited private facilities for attaining
services such as diagnostics, medicine, vaccines or surgeries as an
entitlement, without having to pay at the point of use 1.
Today the union
Budget of 2018-19 took a major step towards Universal health Coverage albeit it
did not declare Health as a fundamental right.
In the current
Budget Government of India (GOI) has moved a step forward towards providing Universal Health
Coverage under National Health Protection Scheme (NHPS), the GOI will
provide health insurance worth Rs 5 lakh to 10 crore poor families across India,
approximately covering 50 crore people
out of 130 crore population with a program almost equal to Universal Health
Coverage. It will be the largest government-funded health insurance
scheme to be implemented anywhere in the world as per available numbers and
statistics.
Under NHPS, as expected poor citizens of India, will get
medical treatment in secondary and tertiary hospitals free of cost covered by
GOI funded Health Insurance. This will be a boon to poor people as “out of
pocket payment” was the single most common cause sudden emergent financial
crisis among rural folk and urban poor of India 2. Each year, as per
available data, more than 40 million people in India, mostly rural folk and
urban poor are impoverished, get entangled in financial crisis and run into
massive debts to access secondary/tertiary/quaternary care in India 3, 4.
This flagship program although not universal, is still welcome.
As per available information, GOI in association with the states will pay a premium of Rs 1000 - 1200 to achieve a cover of Rs 5 lakhs per family per year. This year GOI has already committed Rs 4000 crores and may increase allocation if required.
As per available information, GOI in association with the states will pay a premium of Rs 1000 - 1200 to achieve a cover of Rs 5 lakhs per family per year. This year GOI has already committed Rs 4000 crores and may increase allocation if required.
In addition to the above, GOI will be setting up 1.5 lakh
health and wellness centres or community healthcare clinics across India under
Bharat Ayushman Programme. Under this plan, these 1.5 lakh health centres are a
means to “bring healthcare closer home”, to provide healthcare support for
non-communicable diseases, maternal and childcare services, along with free
drugs and diagnosis. GOI is allotting Rs 1,200 crore for this programme and
said it will ask private enterprises to join the programme as part of corporate
social responsibility (CSR) initiatives.
This flagship primary care program needs to be analysed with
data available on Non Communicable Diseases (NCDs) to understand how important
this initiative is to nation and our healthcare policy. Successive governments
had been asinine in their approach using fiscal prudence, not allocating
adequate funds and policy importance to NCDs 4, 5, 6. NCDs along
with accidents today account for nearly 52% of deaths and effectuate a loss of
6% to our GDP, as economically productive citizens die prematurely 4, 5.
This program is trying to address the growing burden of NCDs and also will go a
long way in reducing burden on our tertiary centres. Since drugs are made
available free of cost, it will ensure compliance of patients and disease
progression along with its complications is stalled 4. This will ensure
better economic productivity of individuals and also better GDP numbers for the
nation. This confirms to the second strategy recommended by yours truly -
excerpts as below:
Second Strategic Intervention
– Establishment Of National Drug Procurement Policy 1:
The “Jinx of 70”, it is well
established that 70 per cent of healthcare expenses are due to cost of
medicines. Right to health and universal health coverage cannot be achieved
without access to affordable essential drugs on a regular and viable basis.
Millions of Indians could access better care, if government decides to procure
generic medicines in bulk and distribute them free of cost at public health
facilities. The government should establish a national drug procurement and
disbursal policy with mandate to procure and provide generic medicine, surgical
implants, stents, devices, suture goods etc..., to all public and private
institutions participating in UHC across the country. Distribution of free
medicines and treatment accessories through public healthcare systems helps
increase citizens trust in our public healthcare system and in the government
of the day 1.
Although Bharat Ayushman Programme does not completely
address, much required Drug policy; it along with Jan Aushadhi Scheme should be
able to complement NHPS to move closer towards the sought after goal of
Universal Health Coverage.
Bharat Ayushman Programme is also in sync with a part of
recommended fourth Strategy where Primary care and prevention is accorded more
importance than say for tertiary care with curative bias. Excerpts:
Fourth Strategic Intervention
– Focus On Impact Areas In Healthcare:
Availability and accessibility
of primary care in the time and place of need especially rural areas leaves an
impact, it also allows the person to suffer minimum in terms of illness and
also economic losses.
Allotting Rs 600 crore at the rate of Rs 500 for every TB
patient every month, to provide nutritional support displays the sincere
thought process of GOI in trying to reduce disease burden on its citizens. TB
is notoriously difficult disease to cure and especially so when nutritional
status of patient is bad.
Government of India, has committed itself to open 24 new
medical colleges including upgrading a few existing colleges and ensure there
is at least one government medical college in every state. This again confirms
to recommendations from another article of mine regarding medical education and
regulation of practice 10.
Overall, this budget of 2018-19 is clearly path-breaking for
sheer size, coverage and amount committed per family almost embracing the holy
grail of Universal Health Coverage. This along with other measures (like
guaranteed minimum income to be rolled out by some states 7, 8, 9) ushers
India firmly in the next generation of social security as India moves
aggressively from a progressive developing economy to a developed economy.
References
1)
Five Strategic Interventions Modi Can
Make To Give India A Far, Far Better Healthcare System https://swarajyamag.com/ideas/five-strategic-interventions-modi-can-make-to-give-india-a-far-far-better-healthcare-system
2)
Trends in catastrophic health expenditure
in India: 1993 to 2014 http://www.who.int/bulletin/volumes/96/1/17-191759/en/
3)
Marten
R, McIntyre D, Travassos C, Shishkin S, Longde W, Reddy et al. An assessment of
progress towards universal health coverage in Brazil, Russia, India, China
& South Africa (BRICS). Lancet 2014; 384: 2164-71).
4)
India’s Public Healthcare System Needs
Urgent Overhaul: Are Those In Authority Listening? https://swarajyamag.com/ideas/indias-public-healthcare-system-needs-urgent-overhaul-are-those-in-authority-listening
5)
WHO
country cooperation strategy at a glance India – 2013: http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_ind_en.pdf
6)
Burden
of NCDs policies and programmes for prevention and control of NCDs in India.
Indian J Community Medicine 2011; 36 (suppl 1): S7-12).
