Why health investment is productive
Jun 18 2014
The Congress pledge of enhancing the health budget from 1 to 3 per cent of the GDP has not borne fruit; any postmortem of their performance in past 10 years would prove that. With 73 per cent citizens going for out of pocket (OOP) expenses to fight disease and infirmity with accruing debts in the process, the Congress track record can be mildly described as abysmal.
The fact is that the common man — the aam aadmi — is going through hell. The BJP, at least in their election manifesto, can be credited with presenting some perspective by including disease preventive schemes with special focus on school children and senior citizens, introduction of a national health assurance scheme, creation of e-health authority and the creation of swacch Bharat (clean India) by 2019.
Aam Aadmi Party (AAP) in its election manifesto devoted just seven lines to health and had expressed the desire to work for ‘right to health’ and generic medicines availability. AAP emphatically advocates that corruption is the only issue, which deserves detailed documentation, rest everything else will automatically fall in place. Perhaps, after examining the multiple acts of omission and commission under national rural health mission (NRHM), the argument possibly looks valid.
There is consensus that the UPA government’s second term in office was largely achieved on the back of the success of social welfare schemes like Mahatma Gandhi National Rural Employment Guarantee Act, (MGNREGA). Across the Atlantic, Barack Obama earned his second US presidential term after promising a health insurance scheme to 300 million Americans, also known as ‘Obamacare’.
With a BJP government in place with a comfortable majority, it is time to implement right to health, which effectively means free treatment facilities to millions of below poverty line (BPL) and above poverty line (ABL) families across the country in the event of accident and illness.
The new government must launch this ambitious new scheme and christen it the Mahatma Gandhi national insurance scheme for health (MGNISH). It should be a joint enterprise of the centre and the state and both private and public hospitals across the country should be made stakeholders.
Certainly, the central nodal agency will be the Union ministry of health and family welfare while the nodal agents would be the state health ministries. The task of the nodal agency is to weave a network of service provider hospitals and insurance companies for cash-free health services.
To be sure, along with MGNISH we need to strengthen the primary, secondary and tertiary health infrastructure in a big way. We need All India Institute of Medical Sciences (AIIMS) in all states, regular payments to voluntary groups, improved anganwadi network and skilled workforce of paramedics and technicians which will not just improve services, but also boost employment.
The synergy between private and public hospitals will benefit the common man and scale down immediate demands for funding from the government’s side. Additionally, the problem of bed occupancy of private setups will be taken care of. MGNISH cannot be built on lines of the rashtriya swasth bima yojna (RSBY). RSBY flopped on two counts; first, the insured amount was a measly Rs 30,000, hardly sufficient for any surgical treatment in private hospitals, and secondly, it did not cover the APL sections of the population.
No poor Indian should be left out. Ideally speaking, people not covered under MGNISH should be those who are covered under other schemes like med claim, ex-servicemen contributory health scheme (ECHS) and central government health scheme (CGHS). Although the task looks daunting, MGNISH will go a long way in ameliorating misery and tears. There is little doubt that the programme will transform human life in India.
To conceptualise and implement a strong successful project, various similar schemes implemented at the state level can be examined. Karnataka has the Yashshwini cooperative farmer’s health scheme, which is very successful and works on the principle of self-financing — Rs 210 per family per year is the annual contribution. The only limitation is citizens outside the cooperatives cannot avail of the benefits.
The Andhra Pradesh government’s successful experience with the Rajiv aarogya shri community health insurance scheme since 2007 covers 223 lakh poor BPL families and allows claims up to Rs 2 lakh on a floater basis. It does not apply to APL and the urban poor. A reasonable modification can be nominal charges for APL families and extending the benefits of the scheme to urban BPL as well. Recently, the Odisha government has launched a health assurance scheme, the Biju krushak kalyan yojna aiming to provide 60 lakh smart cards to farmer families. The considered family unit comprises five members while the contribution is Rs 30 annually, the coverage for which is Rs 1.5 lakh on a floater basis. The state government has hired insurance companies for the job and has allocated Rs 100 crore for 2013-14.
It is important to remember that investment in health is productive expenditure and the most important denominator of dignity and happiness in a civilised world. Let’s have some positive debate and real action to reduce OOP and free the citizens from health debt and misery.
(The writer is chairman, Arthritis Foundation of India)