Budget 2018 and the World’s Largest Healthcare Scheme: Reality or Mirage

The burgeoning Indian healthcare sector is one of the largest contributors to the country’s economy. The sector, therefore, needs proper regulations, a whole lot of policy reforms, and ample government support/funds to progress its growth further. The current state of healthcare in India is struggling with several issues and requires appropriate action across multiple dimensions to achieve the goals of the universal health coverage. With the government announcing several good reforms, the current budget has touched upon the vital areas needed for action with several flagship initiatives, claiming them to constitute the ‘world’s largest health care programme’.

This February 2018, India’s Finance Minister Arun Jaitley announced The Union Budget 2018 for the fiscal year 2018-2019. The major highlights of this budget include notable initiatives focusing on the public health and the Indian healthcare sector. As a part of the announced Ayushman Bharat Programme, the government has come up with two major initiatives in the health sector, aimed at bringing path-breaking interventions to address holistic healthcare in the country.

The healthcare initiatives announced in the budget are expected to provide the necessary health coverage for the most vulnerable, thus, steering the country’s healthcare path onto a progressive one.  With the government healthcare spending abysmally low and the country’s individual health insurance cover being minimal, this initiative is potentially a groundbreaking one in the country. However, in reality, how close does the announced healthcare scheme live up to the hype given by the government? This is something we need to explore.

The Healthcare Initiatives:

The Finance Minister announced the creation of Health and Wellness Centers across the country with the view of bringing healthcare system closer to the homes of people. As per the National Health Policy, 2017, the Health and Wellness Centers were envisioned as the foundation of India’s healthcare system. Now, under this initiative, around 1.5 lakh health and wellness centers are to be established all over the country, providing comprehensive health care facilities, which include healthcare services for non-communicable diseases, maternal, and child health. Apart from that, these centers would provide free essential drugs and diagnostic services for the people. As per the year’s Budget announcement, the government has allocated a sum of INR 1200 crores for this flagship programme. The government has also envisaged that the private sector contributions through CSR and active participation of philanthropic institutions would help to adopt these centers financially.

The second flagship programme announced, as a part of the Ayushman Bharat, is the National Health Protection Scheme. This national scheme is expected to provide a health insurance cover of up to 5 lakh a family per annum for secondary and tertiary hospital care. As announced, the scheme will be covering more than 10 crore vulnerable families in the country. This approximates to around 50 crore beneficiaries across India, which is nearly 40 percent of the country’s total population, thus, making this scheme the ‘world’s largest government-funded healthcare programme’.

The beneficiaries of the scheme would be identified on the basis of deprivation indicators as noted from the Socio-Economic Caste Census. So far, there have been about 10 crores destitute families, who would be covered under the new scheme. As mentioned by Arun Jaitley, the government will be allotting adequate funds as and when required for smooth implementation of this programme. It is estimated that the total cost would be up to 12,000 crores annually and an initial allocation of 2,000 crores for the scheme has been announced. It is however yet to be considered whether the NHPS Scheme will be run through a trust-based model or the general insurance companies. Already, certain states are successfully running their own healthcare schemes using a trust-based model. Through this model, the government will set up a trust with funds being contributed by both the states and the Centre to settle the hospital claims of beneficiaries, in place of insurers.

It is said that the health ministry will draft the scheme thoroughly and probably launch it either on August 15 or October 2, after consulting the states. Since several states are already running similar schemes for specific illnesses, there would be further discussion on how to streamline or merge those schemes along with this NHPS. In Centre, the existing Rashtriya Swasthya Bima Yojana (RSBY) would be subsumed within this NHPS.

Reality or Mirage!!

With the proponents of the initiative lauding the government for its scheme, there are several opponents stating that the Union Budget 2018-19 is making tall claims, with no clear roadmap for the healthcare sector to meet the needs of the poor and vulnerable population. The reason why the scheme is considered a mirage is that the increase in the insurance coverage from 1.5 lakhs to 5 lakhs hardly gives any advantage to the beneficiaries but instead satisfies a totally different set of corporate players, particularly the hospital chains and commercial insurance companies.

Touted as “world’s largest government-funded healthcare programme”, this NHPS scheme is questioned as an overstatement of the reality. This is because the 30,000 crores budgeted National Health Mission covering the entire 130 crore population is a much larger scheme compared to this funded insurance coverage. Moreover, why is the government equating health care with health insurance but neglecting the public health services? Isn’t it important for the government to strengthen the public health system with more resources rather than allocating funds for the insurance schemes?

The Union Budget 2018-19 healthcare initiatives, thus, is largely being seen as a mirage than a reality, as it continues to neglect the public health system and fails to address the critical issues of the healthcare system of India.