Call it ModiCare or NaMoCare, the Budget 2018 announcement on upping the stakes with the National Health Protection Scheme (NHPS), is an acceptance of reality, finally, by the government that no poverty alleviation is going to happen till healthcare costs stop dragging people back into impoverishment.
Having worked in the hinterlands of the Himalayas in Uttarakhand for the last five years, I have seen a tragedy unfold multiple times across communities. Exactly in the year that a family looks forward to a surplus in earnings that can help them invest in a better future, an illness will strike. A healthcare bill of just Rs 25,000 in a year for a family that barely earns Rs 1,00,000+ annually is enough to trap them in a debt cycle for three to four years.
This announcement that 10 crore families will soon have access to a family health cover of Rs 5 lakhs per year, is good news indeed. In one stroke, it will lift healthcare affordability for these families to almost middle class levels. Rs 5 lakhs is a decent sum of money and comfortably cover two hospitalizations in a year in a family, in a worst case scenario.
But this is just the start. In India many healthcare schemes have been floated over the years at state and central level, complete with smart cards et al. As is the case always with India, implementation is the inevitable slip between the lip and the cup. A lot of us are going to be eagerly awaiting information on how actually the NHPS is going to be implemented on the ground. If you want to go by past experience, it is best to take today’s announcement with a pinch of salt.
For the NHPS to truly change the face of health in India, multiple challenges need to be solved. First up, is making accessing NHPS a cashless experience for patients, and efficiently. Past efforts in claiming any state health benefits have involved running from pillar to post, and/or waiting forever for a refund to materialise. There have been successful cashless pilot initiatives in many parts of the country, but it remains to be seen how it will work when faced with a scale of 50 crore potential claims.
Clearly, this is going to be an initiative led through participation of insurance companies. The scale of claims simply cannot be covered by the government. But the mediclaim insurance industry in India is today the ‘wild wild west’, with hospitals, companies and intermediaries, all sniping at each other. For a private policy holder itself, the process of going through a mediclaim is daunting, it is going to take some epic capacity building for this structure to handle 50 crore potential claims.
A lot of people might not agree on an insurance-based model, but one issue everyone agrees on is that ancillary costs of accessing healthcare need to be addressed. It is an equally crippling burden for the impoverished to access healthcare in far away towns or cities when they have to bear the costs of travel, accommodation and other costs for the patient and attendants. Sometimes this burden delays the decision to access healthcare, thus increasing the cost of eventual treatment.
The only answer is to bring healthcare closer to recipients. Specialised care needs to be accessible to the hinterland. Thus this NHPS announcement will be greeted with appreciation by initiatives such as Dr Devi Shetty’s Narayana Hrudayalaya, who want to scale affordable healthcare to the masses. Further, this also opens up new opportunities for the non-profit sector to work in delivering healthcare if the costs can be paid directly by the patient’s policy, instead of trying to be a government contractor dependent on the whims and fancies of tendered procurement of services.
With the government opening the door for the private sector to offer services to the masses, the inevitable question is soon bound to be asked – who is better at delivering healthcare services, the government or private sector? The writing has been on the wall for the last two decades that at least for specialised healthcare interventions, the government has no chance in hell of catching up and delivering at scale. Thus one can now only hope that the first claim settlements through the NHPS happen before the 2019 elections, and it then leads to quality debate on how exactly the government needs to be involved in healthcare service delivery.
(The writer runs a non-profit organisation called Kalap Trust in Uttarakhand. He is currently working on models to deliver healthcare to the doorstep of communities in the mountains.)