Sreelatha Menon: Right pill for the poor

Govt decision to roll out national health insurance across the country has earned praise

The government decision to roll out the national health insurance programme throughout the country has earned praise from all quarters.

Medicines and doctors heal the sick but leave them poorer. The recent decision to roll out the national health insurance programme in all the districts is therefore the most significant poverty alleviation initiative where the beneficiary is more empowered than even a worker under the National Rural Employment Guarantee Scheme.

Under the programme, the beneficiary gets a smart card which ensures that his or family’s (a total of five members) hospital bills are taken care of by a number of hospitals listed under the Rashtriya Swasthya Bima Yojana.

The programme has its origins in Haryana, where Chief Minister Bhupinder Singh Hooda requested Prime Minister Manmohan Singh for permission to roll out the scheme in all districts of the state in September last year. This was followed by requests from Gujarat, Kerala and Uttar Pradesh. Seeing this rainbow of accord among different political parties, the government decided last month to extend the scheme to all districts in the country.

The fact that the beneficiary pays just Rs 30 a year and the government just pays the premium of around Rs 600 for a total annual entitlement of healthcare worth Rs 30,000, makes the scheme attractive.

Everyone is a winner here — the patient, the hospital, the insurance company, the smart card company and of course the government, says the man who has been pushing the scheme — Labour Welfare Commissioner Anil Swarup.

The patient is protected against poor quality of service by a vigilant insurance company that tracks every single hospitalisation case to prevent cheating. However, loopholes remain: there is no centralised system of monitoring the drugs prescribed, as is the case with the British healthcare system.

An impressed visitor from Gates Foundation wrote recently: ICICI Lombard, while enrolling beneficiaries in Haryana, had a system of sending an SMS to the phone of the regional healthcare manager of the insurance company whenever a patient visited an empanelled hospital in the state. All in all a very impressive site to behold.

Last month, the labour ministry decided to include maternity cases under the scheme, giving a huge boost to the health ministry’s efforts to expand institutional delivery.

That private hospitals are not the only once empanelled makes the scheme a mechanism to incentivise government health providers.

For once, the government has a scheme where it can take credit and praise for doing so much at such a small expense — Rs 250 crore this year for the 2.4 million smart cards so far. Compare this to the Rs 30,000 crore being spent this year on the National Rural Employment Guarantee Scheme and beneficiaries getting an average of Rs 4,000 a year!

The target is to bring all BPL families under the programme, which means 18 million families in Uttar Pradesh, 7.4 million in Bihar, 6.4 million in Maharashtra and so on. Swarup says it may take three years to cover all of them.