A valid proposal

But a new health authority shouldn't usurp states' powers

The National Institution for Transforming India, or NITI Aayog, has reportedly proposed the creation of a new National Health Authority. This authority will oversee the new universal health insurance scheme, variously called Ayushman Bharat, the Pradhan Mantri Jan Arogya Yojana, or the National Health Protection Scheme (NHPS). The goal of the NHPS is to enable universal access to health care, at all three levels of service. The crucial element of the scheme is to provide 100 million poor families with access to public and private hospitals with government-guaranteed insurance cover up till Rs 500,000. The exact design of the scheme has been left up to various states, and they have chosen different mechanisms for delivery, some based on their existing health provision plans. The scheme was rolled out earlier this year after being announced in the Union Budget for 2018-19. But there are major questions about its costing, the infrastructure required, and the supply constraints in the health care sector that are yet to be answered. 

While the foundation of a new body to oversee the NHPS is a welcome suggestion, by itself, it will not cause these problems to be solved. However, it may address two additional concerns. The first is the shortage of capacity in many states at the administrative level that could manage the extra monitoring and supervision involved. The second is in laying down uniform standards and access rules that could allow free movement between different jurisdictions without losing access to health care or to health information. The latter in particular is shaping up to be a major problem in the future. At all costs, India must avoid creating a balkanised health care system that becomes another disincentive for useful migration from labour-surplus areas to those parts of the country where wages are higher. 

Given that the NHPS is a major social-sector initiative, perhaps the most important such new move under the current National Democratic Alliance government, it is welcome that the government is considering what institutional architecture would complement the new scheme. It is thus essential to create an authority that can give the scheme its focused attention. That said, however, the lessons of previous centrally-sponsored schemes should be taken into account. The crucial determinants of any scheme’s success lie at the state government level. The experience from previous centrally-sponsored schemes is that line ministries have often created too many requirements and required excessive standardisation. These have meant that the administration of schemes is not as accountable or efficient as it would be otherwise. This must not be repeated in the case of the NHPS. An independent authority that is not under the Union health ministry provides for the chance of less interference, but it should ensure that the NHPS does not turn into a purely central scheme with little involvement from the states. In general, however, the Union health ministry’s sensible points about limiting private control of public hospitals should also be taken into account in the scheme’s design.