Letters: Not apt conclusions

The editorial, "Govt health insurance will only make pvt hospitals richer" (December 29), is too simplistic and rather misplaced. Kindly let me respond to it succinctly.

The direct benefits transfer platform, or JAM - Jan-Dhan Yojana, Aadhaar and mobiles - is the right way forward as it would minimise leakage and target the people actually in need and at the time they need it. All 29 states must take the lead in ensuring that processes are carried out smoothly so that citizens find it easy to avail of such schemes. This is an area where systems across several countries in Asia find it difficult to cope with. Yet Thailand's universal health coverage programme is a good starting point to understand how a scheme should be implemented. The country started its 30-baht scheme - as it was originally called - in 2005-06 and now, it is widely acknowledged as a success.

The editorial says that in India even well-implemented schemes such as Andhra Pradesh's long-running medical insurance programme, Aarogyasri, found it tough to cope with the demands of cost increases from private hospitals. But consider this: The cost of radiation therapy for treatment of cancer in private hospitals is three to four times that under Aarogyasri. Despite such disparities, the intake of patients in private hospitals is not significantly low. Generally, hospitals - whether private or government-run - are operating to near-full capacity in treating cancer through radiation therapy.

Where the editorial says that the Aarogyasri in Andhra Pradesh has a bias towards paying for serious and instrusive procedures, it is natural that people are more likely to claim insurance when the charges are high. Affordability and aggregate out-of-pocket payment are key determinants. Nonetheless, the liability on the person who is paying - under Aarogyasri, this would be the government - will continue to rise not only per capita, but also as an aggregate, as incidence and prevalence of diseases both increase.

In the first instance, the issue is of generating adequate funds to pay for the prevention, diagnosis and treatment of a disease, not just to try and reduce the treatment cost. The experience of implementing insurance schemes in Andhra Pradesh and Gujarat, to name just two states, has been positive. It indicates the need to put in place an insurance coverage mechanism that will generate adequate funds at the level of the central government, which can then distribute these to the states for use in health care.

The editorial says that better healthcare in India is a moral and practical necessity. But health infrastructure in the country is led by the private sector and would continue to be so in the foreseeable future. Even the addition of new capacity for treatment is being driven by the private sector. Would the sector not strive to make it profitable and sustainable? But who will pay for such capital expenditure?

Praneet Mehrotra Singapore

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