Yesterday, at the Union Budget 2018 session the Finance Minister Arun Jaitley spoke about the world’s largest Government funded National Health Protection Scheme (NHPS) for India. This mega health insurance scheme for the poor is said to boost the health sector in India. The NHPS will cost the Indian Government over Rs. 1 lakh crore. It is said NHPS will provide 100 million families with medical coverage up to Rs. 5 lakh per. This will be given for secondary and tertiary care hospitalisation.
The existing health scheme Rashtriya Swasthya Bima Yojana (RSBY) provides a cover of Rs. 30,000 for up to 5 members of a Below Poverty Line (BPL) family. Around 36 million of the 59 million BPL families across 15 states are enrolled in RSBY scheme. The allocation for RSBY increased to Rs. 2,000 crore for the Financial Year 2019 (FY 19.) Previously, for FY 18 the amount was Rs. 470.52 crore.
The former Finance Minister (FM) P. Chidambaram said, “If the insurance companies will foot the bill, the premium at Rs. 5,000 to Rs. 15,000 per family will require an outgo of Rs. 50,000 to Rs. 150,000 crores per year. Is the FM serious?”
A Health Economist Indranil Mukhopadhyay said, “The scheme announced would mean the Government would be required to spend at least Rs. 1.2 lakh crore in premiums to private health insurance firms to extend coverage to 50 crore people.”
Jaitley responded saying the Government has not yet made any allocations for the scheme. Adequate funds will be provided for smooth implementation of this program.
The Healthcare providers welcomed the NHPS with open arms. The Managing Director (MD) of Apollo Hospitals Enterprise Suneeta Reddy said, “This will be a big boost for us. The current insurance schemes were unviable, but with the increase in cover, I think we will see a growth in our state sponsored scheme patients.”
The former Health Secretary K. Sujatha Rao said a good healthcare delivery system providing services of reasonable quality is necessary for people to take advantage of this scheme. She further added the Government will either have to raise a public investment to strengthen its own service delivery system or incentivise the private sector by providing the necessary market.
The former Finance Secretary Arvind Mayaram tweeted saying, “Universal health insurance through private hospitals has not worked for the poor anywhere. Biggest beneficiaries are the private hospitals and insurance companies. There is no substitute for public health care. More money should have been pumped to strengthen it.”
The Chairperson of the Governing Board of the Population Foundation of India (PFI) and the former Union Health Secretary retaliated in a tweet saying, “Need to look at the details but surely this vast outlay could have been used to strengthen the public health system and improve Government medical and nursing colleges? Employ more people, pay better salaries? Why transfer funds to private hospitals? twitter.com/AnooBhu/status…”
It is said NHPS is the fourth iteration of the RSBY. In the FY 2016 to 2017 RSBY was renamed as Rashtriya Swasthya Suraksha Yojana (RSSY) and for the FY 2017 to 2018 the Government renamed it to NHPS.
The amount of Rs. 5 lakhs per family under NHPS is a massive hike on par with the existing Rs. 1 lakh. It is said this amount is around 17 times higher than the previous RSBY scheme. The NHPS is said to cover around 40% of India’s population.
During the FY 2016 to 2017, the RSBY targeted 5.9 crores families but the Indian Government only managed to enrol 3.6 crores families. The Government’s announcement of reaching up to 10 crores families sounds like a good joke.
The funds’ allocation for RSBY was deteriorating over the last few years of the United Progressive Alliance (UPA) Government. In FY 2012 to 2013 the amount was Rs. 1,001 crore and it reduced to Rs. 550 crore in FY 2014 to 2015. The funds’ allocation was brought back to Rs. 1000 crore last year.
In the last few years of RSBY, the amount of funds allocated and the amount of funds utilized deteriorated drastically. It is said only a total of 8 states utilized the funds given under RSBY. Chhattisgarh is the only state that utilized the maximum amount of funds given under RSBY. Other two states with comparable utilization are Kerala and Odisha. A report from Chhattisgarh shows that several private hospitals forced people to pay additional money even after utilizing RSBY insurance funds.
The administration of these schemes also changed along with the names. The Ministry of Labour and Employment handled RSBY. When the name changed to RSSY, the administration was shifted to the Ministry of Health and Family Welfare.
It is said the NHPS was announced in the Union Budget Session 2018, was lying dormant with the Union Cabinet since November 2016. The NHPS plan was announced by the Prime Minister Narendra Modi at his Independence Day speech in 2016.
