Anchor: Teena Jha
Importance of this Episode:
- Health and Economy have a direct correlation. As the economy of a country improves, the health of its citizens improve and vice-versa.
- Thus, for any country to progress, it’s important that its citizens remain healthy, live longer and are more productive. But health also presents a challenge for countries, especially those with a vast population like India’s. Despite being one of the fastest growing economies of the world, India’s public healthcare system is in a state of crisis.
- According to the ‘National Health Profile 2017’, the country has just a little over 1 million allopathic doctors to treat its population of 1.3 Billion people. And of these, only about 10% work in the public health sector. According to the World Health Organization (WHO) only 1 in 5 doctors in the rural areas are qualified to practice medicine.
- Data from the 4th National Family Health Survey shows that less than half of urban as well as rural India, opt for Government Health Services. However, all of this might just be a thing of the past if the Modi Government’s ambitious health scheme, “Ayushman Bharat”, is implemented successfully.
- The National Health Protection Scheme will cover over 10 crore poor and vulnerable families, providing coverage up to 5 Lakh rupees per family, per year for secondary and tertiary hospitalization.
- This edition of “In Depth” explores various features of this Centrally Sponsored Scheme (CSS), the implementation strategy of the Modi Government to maximize impact and the various challenges it faces to make the program a success.
- The Modi Government’s initiative, Ayushman Bharat is going to play a vital role in improving healthcare and the access to it across the nation. The scheme would be most beneficial to the weaker sections of the society.
Analysis by the Experts:
- The poor condition of healthcare in the country is not a secret, especially in India’s villages where infrastructure is in a dilapidated state. Government hospitals often fail to provide necessary health services to the poor, with private hospitals being out of the reach of most people. The country’s growing population and lack of resources have made matters worse.
- According to the 2011 census, India’s population is over 1.2 Billion, make it the second most populous nation in the world after, China.
- Many organizations, including the United Nations have estimated that by 2025, India would be the most populated nation in the world, surpassing China. This will definitely lead to a higher demand of healthcare services.
- India ranks high in the list of ‘most ill’ nations. On an average, every fifth patient in the world is an Indian. The number of malnourished children in India is more than that in Africa. A large percentage of the Indian population suffers from Anaemia.
- More than 32% of total deaths in India are due to heart-related ailments. According to the Global Burden of Disease study, India is ranked low in the Healthcare index; India stands at a rank of 154. This index is out of 194 countries. But despite this, the budget allotment on healthcare services is extremely low. India spends less than 2% of its GDP on public healthcare. But now the Government is working on improving public healthcare services. The National Health Protection Mission or Ayushman Bharat Yojana, launched by the Government is the first major step in this direction. Ayushman Bharat Yojana is a program which aims to create a healthy, capable and content new India. It will also focus on the poor and weaker sections of the society. It aims to provide insurance of up to 5 lakh rupees to each family. The new scheme also intends to improve secondary and tertiary healthcare services for crores of Indians.
- On the 1st of February 2018, the Finance Minister, Arun Jaitley unveiled the largest government-funded health program. It was called Ayushman Bharat, in his Union Budget presentation. This flagship scheme aims to benefit more than 37% of the population. Thus, nearly all poor and vulnerable sections of our society will be covered. The government will require 12,000 crore rupees for its implementation. This will be shared on a 60:40 basis between the central government and the state governments.
How does this scheme aim to be a game-changer?
- Public healthcare in India has been a problem area for long. Despite a vast population, India spends only a little over 1% of its GDP on public healthcare which is one of the lowest levels in the world.
- Besides this, abject poverty and the huge population make effective implementation of health schemes a challenge for successive governments. Since independence, a number of health schemes have been announced for the poor and the marginalized but none of them have a confidence-inducing record. The current government announced an ambitious health insurance scheme in its annual budget this year, 2018. Called Ayushman Bharat, the schemes assures a health insurance cover of up to 5 lakh rupees per family, per year to 500 million poor and vulnerable people.
- Once it takes off, it will be the world’s largest government-funded healthcare programme.
Ayushman Bharat has twin missions:
- The first is to create a network of health and wellness centres that will bring the healthcare system closer to the people. The centres will provide comprehensive healthcare, including treatment for non-communicable diseases and maternal and child health services. Besides this, they will also provide free essential drugs and diagnostic services; also Rs. 1200 crore have been allocated for this flagship programme.
The scheme will cover more than 10 crore poor families, which is approximately 50 crore persons. It will also setup wellness centres which will give poor people OPD facility near their homes.
- The second flagship programme under ‘Ayushman Bharat’ is the ‘National Health Protection Scheme’. The National Health Protection Scheme will cover over 10 crore poor and vulnerable families. It will provide coverage up to 5 lakh rupees per family, per year for secondary and tertiary care hospitalization.
The government says that these two healthcare sector initiatives under the Ayushman Bharat scheme will build a new India by the year 2022 and ensure enhanced productivity, well being and avert weight-loss and impoverishment. Besides, these schemes will also generate lakhs of jobs, particularly for women. The Ayushman Bharat scheme was launched by Prime Minister Narendra Modi on the 14th of April 2018, in Bijapur, Chattisgarh. The PM inaugurated the first health center under the scheme in this naxal affected district in Bastar region. Under Ayushman Bharat, the Government aims to setup 5 lakh wellness centers across the country by 2022. These wellness centers will be equipped to treat a host of diseases, including blood pressure, diabetes, cancer and old-age illnesses.
The centre has also included 1354 packages in its ambitious National Health Protection Mission under which the treatment for coronary bypass, knee replacements and stenting, among others would be provided at 15-20% cheaper rates than the Central Government Health Scheme. The National Health Protection Mission will subsume the ongoing centrally sponsored schemes: Rashtriya Swasthya Bima Yojana and the Senior Citizen Health Insurance Scheme.
The need for the National Health Protection Mission arose keeping in view the poor health and the healthcare conditions in India. Healthcare services in India have not been able to keep pace with the increasing population. While the government setup lacks behind, private hospitals remain out of reach for the common man due to inflated treatment costs.
A note on the Private healthcare sector
- In India, the private sector accounts for nearly 70% of the total expenditure on health services. This means that out of the total amount of money spent on the development of health services, nearly two-thirds happens in the private sector. Many private hospitals are run under CSR or charitable trust schemes, but they end up providing healthcare for huge profits. Lakhs of people lose their lives every year, because they fail to get the right treatment at the right time, making it imperative for changes to be made in this sector
- In 1946, the Health Survey and Development Committee, headed by the then Diwan of Cochin Sir Joseph William Bhore was formed to chart a course for public health investments and infrastructure in India. The committee advocated free health services to all citizens by the state. It recommended that the government must make at least one primary health centre for every 40,000 people.
- The committee also recommended a 75-bed hospital for every one lakh population.
- Further, a 50 bed hospital for every 30 primary health centres.
- It also recommended a 2400-bed hospital and a medical college at each district headquarters.
- In addition, the committee emphasized on the need to create and run special programmes against tuberculosis, malaria, cholera, and vector-borne diseases. The committee said that almost 15% of the Government budget should be dedicated towards public health programmes.
- But, unfortunately, even after 70 years of independence, the Bhore committee recommendations, are yet to be fully implemented.
- Amid poor healthcare services being provided by the government, private hospitals are flourishing in India. In just the last decade, hospitalization costs have increased by a massive 300%. This indicates that a large chunk of household savings go into health insurance. In 2008, the UPA government implemented the National Health Insurance Scheme, which provided medical coverage worth 3lakh rupees to a family of 5 members, working in the unorganized sector. Similar schemes were also introduced at the state level, but none of these schemes followed a particular standard. The objective of the National Health Protection Mission launched by the Modi Government, is to standardize all these schemes- to provide the same level of treatment to the people. The scheme also aims to improve coverage and reach out to a large number of people.
- The Government claims that treatment under the National Health Protection Scheme will be affordable by the common man. This scheme, popularly referred to as Modicare will offer 20% lower rates than even the Central Government Health Scheme rates.
- In a move likely to set new pricing standards for medical procedures in the country, the health ministry has prepared a rate list of 1354 packages, which will be covered under the National Health Protection Scheme. The packages include 23 specialties including cardiology, orthopaedics, ophthalmology, neurology and oncology.
- The rates of the packages have been finalized after analysing the Central Government Health Scheme (CGHS) rates and are on an average 15-20% lower than that of the CGHS. The implementation of the new scheme will incur an approximate cost of 11,000 crore rupees every year on the exchequer with an estimated cost of insuring each family at about 1,100/- Rupees. These expenses will be borne by both the Central as well as the State Governments.
- Under this scheme a rate card has been issued for several common procedures; for instance, the Government has fixed the rates for vertebral angioplasty with double stent at Rs. 65,000/-
- Similarly, the price for total knee replacement is fixed at Rs. 80,000/- whereas a C-section will cost Rs. 9,000/- Further Rs. 1,10,000/- will be charged for Bypass surgery; Rs. 90,000/- for hip replacement; Rs. 40,000/- for a heart stent; Rs. 25,000/- for a knee surgery and Rs. 20,000/- for a cervical surgery.
- The Government will upload the complete list of treatment packages for the health insurance scheme on the portal of the ministry.
- In order to increase the number of empanelled hospitals under NHPS, the health ministry will also provide incentives up to 30% to private hospitals. The Government is confident of treatment under this scheme will be very cheap. Under this scheme, the Central Government will also add the RSBY (Rashtriya Swasthya Bima Yojana), and the Senior Citizen Health Insurance Scheme. The Government is also planning to link this scheme with Aadhar to keep a check on frauds.
- Ever since the announcement of the universal health insurance scheme under Ayushman Bharat, there has been a lot of discussion as to how it should be implemented. The critics of the policy cite a lack of basic infrastructure and funds, while the Government claims that necessary homework has been done and that it will bring revolutionary changes in the countries health system.
What the critics say?
- They want to know as to how the Government would raise the money and the resources to meet the financial demands of this ambitious scheme.
The Way Ahead:
- The Government, however, seems confident to be able to generate money from the 1% increase in the Cess on health and education to implement this scheme. It is estimated that the Government would raise approximately 11,000 crore rupees from the 1% Cess.
- The second question about this scheme is the lack of basic infrastructure. Critics believe that less than one and a half percent of the country’s GDP is being spent on the health sector which creates an uncertainty about the program. However, the Government says that the expenditure on health services will increase after this scheme is implemented. A draft has been prepared for this. For this, on the national level, the ‘Ayushman Bharat-National Health Protection Mission Agency’ will be formulated. The Government will also advice states to implement the scheme through a dedicated State Health Agency (SHA).
- The States can also setup new agency apart from the existing trusts, societies, non-profit companies, or state nodal agencies.
- State schemes can be implemented through insurance companies or through an agency or integrated model.
- A large part of India’s population lives below the poverty line. In the last 10 years, the cost of hospitalization has gone up by 300%.
- Of this, more than 80% of the expenditure is incurred by the individual.
- Rural households spend 68% of their family income or savings on treating illnesses; while 25% of the expenditure (for treatment) is arranged through borrowing.
- In contrast, urban families spend 75% of their savings on hospital expenses. In India, about 60% of the amount earned is spent on healthcare, and this forces around 60 lakh families to live in poverty due to healthcare expenses.
- The Government claims that the new health insurance scheme will help people save money.
- Furthermore, the expenses incurred for the payment of the premium for this scheme will be shared by both the central as well as the state governments.
UPSC aspirants are advised to read the latest available press-releases available on the PIB (Press Information Bureau) website.
Read more Gist of Rajya Sabha TV to help you ace current affairs in the IAS exam.