Mahesh Vijapurkar

There are fuzzy lines around the National Health Protection Scheme (NHPS), “the largest Government funded health care programme in the world”, as brandished in the Budget announcement itself. Ten crore families being covered, with an average of five member per family is 50 cr Indians amount to about a third of the population.

A coverage of Rs 5 lakh per annum is a blessing for families, most of which can hardly meet even the out of pocket expenses of medicare – travel to a decent health provider, loss of wages etc – and tragedies befall the families. It could be the death of the wage earner, or loans from all and sundry including the usurious moneylenders.

However, we still do not know when and how this would be rolled out because even the government which conceived and announced the scheme has not told us how much it would cost. Without that, any scheme may not be given life to. If rolled out, we do not know how states would respond because it appears they have to bear 40 per cent of the cost.

No state would like to avoid it, but they too would have to redesign their finances, which is not easy. A research paper published as a blog on the portal of the National institute of Public Finance and Policy has raised serious doubts about the rolling out itself. NIPFP’s governing body has representatives of the Finance Ministry, NITI, and the RBI plus others.

The author, Mita Choudhury, a faculty, points out, “The NHPS was announced by the FM in his budget speech of 2016, then with an insurance coverage for hospitalisation expenditures up to Rs. 1 lakh per annum for each BPL family. The scheme was, however, not rolled out, and the 2017 budget speech had no mention of the scheme.

It leaves us to assume that the former idea was merged with the new, but we still have no answers as to why it remained an idea on the paper. However, the quantum of funds required to launch it is varying, depending on who puts it out, and the timeline to bring it to life remains unspoken though six months ahead is one tentative suggestion.

Having said that, there is another serious issue that needs to be understood. Hospitals, all in the private sector, are notorious for padding up costs and even conducting avoidable procedures. Even if the insurers disallow some of it, the other inflated costs accrue to the patient’s lot. It is normal to see a 30 per cent padding moment the hospitals realise the patient was insured.

Fifty crore people, each of them entitled to Rs 5 lakh per annum of health care would be the boom that that would make the private healthcare sector drool. Though their capacities are already nearly overused, this sector would most likely add to it swiftly because it is a market that has to be captured. Those who were earlier turned away from even Trust-hospitals would be wooed.

This is possible because the publicly funded healthcare system is rickety, and those that exist are poorly run, both administratively and medically. Shortage of doctors, drugs, its sparse presence as a ratio of the demand never met are the public system’s bane. The announced intent of beefing up the system is, knowing how governments run their projects, is likely to be slow, and enable the high-billing private sector to make hay.

When the Centre itself has not allocated enough for the NHPS, and there is no enthusiasm for the States to improve the primary centres which are the critical gates to healthcare, even the talk of 1.5 lakh Health and Wellness Centres with an allocation of Rs 1,200 cr seems a big target. The very fact that the private sector and philanthropists to contribute makes the government’s own “commitment” of funds rather iffy.