Health for all

New health insurance push needs thought

The proposed National Health Assurance Mission is slated to provide basic health services, including essential medicines and diagnostic facilities, along with insurance cover to take care of basic health needs. While the premium for people below the poverty line is to be borne by the government, others will have to pay, though at subsidised rates. To be rolled out in phases from next year, the mission will ultimately subsume the ongoing National Rural Health Mission and universalise the coverage of the Rashtriya Swasthya Bima Yojana launched by the previous United Progressive Alliance government for those falling in the poverty bracket.

This massive social sector programme will be expensive. A reasonable estimate of costs is not yet available. Currently, much health spending is by uninsured individuals, and has nearly doubled between 2000 and 2012. On average, two-thirds of medical expenses are out-of-pocket. Unsurprisingly, about 40 per cent of those needing hospitalisation have to borrow money or sell assets to meet the costs. Worse still, over 20 per cent of the sick do not seek medical help. The condition of healthcare sector in rural India is particularly deplorable. Of the country's total healthcare infrastructure, hardly one-third is located in the rural belt where the bulk of the population lives. The National Health Profile 2013, compiled by the Central Bureau of Health Intelligence, reveals that around eight per cent of the rural primary health centres do not have a qualified doctor, and about 40 per cent of them lack laboratory technicians and other supportive staff. Much of the expansion in health infrastructure in recent years has been in urban areas and in the private sector. Though a sizable part of the new health facilities is truly world-class - which is reflected in the sharp rise in medical tourism - the cost of their services is prohibitive even for a section of the middle class, leave alone the poor.

That explains the pressing need to expand and, more importantly, revamp as well as upgrade the public healthcare network. Apart from opening new hospitals and primary healthcare units, more doctors and supportive staff will need to be hired to man these centres. This will need meticulous planning and expeditious action. The requirement of doctors alone is assessed to rise threefold. This will call for huge fresh investments in setting up new medical colleges and other facilities for producing more doctors and trained paramedical personnel. But public-private partnerships in health have yielded sub-optimal results in many ways, featuring poor quality control and cost escalation. The government, too, will have to step up its public health spending from the present low of just around one per cent of the gross domestic product (GDP) to around four per cent. However, given the criticality of the task at hand, this cost will need to be met. Otherwise, the country will continue to incur a far higher cost by way of productivity loss due to ill health.