New Delhi: Will the National Health Protection Scheme (NHPS), claimed to be the world’s largest health cover, prove to be a reality?

Though the healthcare sector in Union Budget 2018 received a meagre hike of 11.5%, NHPS, dubbed as Modicare, gained all the attention across various corners. With the history of government health insurance schemes not so impressive, the Modi government now has a major challenge before it to implement the scheme effectively.

Currently there are six major public health insurance schemes run by the government—Rashtriya Swasthya Bima Yojana (RSBY), Employees’ State Insurance Scheme (ESIS), Central Government Health Scheme (CGHS), Aam Aadmi Bima Yojana (AABY), Janashree Bima Yojana (JBY) and Universal Health Insurance Scheme (UHIS).

Further, with the government’s own admission, the recently released National Family Health Survey (NFHS-4) by the ministry of health and family welfare depicts that health insurance coverage in India is far from satisfactory, especially in rural areas. According to the survey, less than one-third (29%) of households have at least one member covered under health insurance or health scheme. Only 20% of women aged 15-49 and 23% of men aged 15-49 are covered by a health insurance or health scheme.

The survey said that half of those with insurance are covered by a state health scheme and more than one-third by RSBY. The beneficiaries under the government’s ambitious RSBY scheme in 2017 were 36,332,475. Only 4% of women and 3-5% of men are covered by ESIS or CGHS.

According to public health experts, programmes such as CGHS and RSBY, which can serve as change agents for strengthening healthcare and achieving universal health coverage, have either failed in implementation or have been ineffective in offering access to healthcare.

“At the claims stage, misutilization or fraud can take multiple forms. There is lack of robust management information systems in the CGHS which compromises the ability of these schemes to purchase effectively, control costs, and measure performance," said Raj Panda, senior public health specialist with Public Health Foundation of India (PHFI), a health research organization.

A 2017 study published in PLOS One journal, Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India, said that while utilization of healthcare improved among those enrolled in various government schemes, there is no clear evidence yet to suggest that these have resulted in reduced OoP (out of pocket) expenditure or higher financial risk protection.

The study, done by School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, and Indian Institute of Public Health, said, “Firstly, benefits of these demand-side financing mechanisms will be not reaped unless the basic health care infrastructure for delivery of primary health services is strong. This primary health care infrastructure will be necessary to provide basic health services, besides serving as gate keeping for specialist services."

Coming down to the execution of health insurance schemes, finance minister Arun Jaitley, in budget 2016-17, announced that the government will launch a new health protection scheme to provide health cover up to Rs1 lakh per family. The scheme is yet to see light of the day as it is pending for approval in the cabinet for over a year.

“The government has to match up with a strong regulatory framework and clear financial outlays and implementation plans for the announced schemes. While universal access to healthcare services remains a distant dream with the current allocation strategies of the government, resource prioritization is the key to effectively utilise the available budgets for primary healthcare," said Poonam Muttreja, executive director, Population Foundation of India, a policy advocacy and research organization.

The health ministry received a total of Rs52,800 crore in comparison Rs47,353 crore from the previous year.

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