Making health insurance work 

Making health insurance work 

Context:

• The National Health Protection Scheme is disconnected from primary care.
• The previous government failed to implement the recommendations of the High-Level Expert Group on Universal Health Coverage (2011).

The Union Budget 2018 resonate those recommendations with commitment to universal health coverage which includes:

1-       Strengthening of primary health care, linking new medical colleges to upgraded district hospitals,

2-       Provision of free drugs and diagnostics at public health facilities.

3-       Stepping up financial protection for health care through a government-funded programmed that merges Central and State health insurance schemes.

About NHPS:

•   The scheme will provide cost coverage, up to ₹5 lakh annually, to a poor family for hospitalisation in an empanelled public or private hospital.
• The precursor of the National Health Protection Scheme (NHPS), the Rashtriya Swasthya Bima Yojana (RSBY), provided limited coverage of only ₹30,000, usually for secondary care.

Loopholes:

• Though it improved access to health care, it did not reduce out-of-pocket expenditure (OOPE), catastrophic health expenditure or health payment-induced poverty.
• The NHPS addresses those concerns by sharply raising the coverage cap, but shares with the RSBY the weakness of not covering outpatient care which accounts for the largest fraction of OOPE.
• The NHPS too remains disconnected from primary care.
• The NHPS will pay for the hospitalisation costs of its beneficiaries through ‘strategic purchasing’ from public and private hospitals.

Way ahead:

• Well-defined list of conditions that will be covered, adoption of standard clinical guidelines for diagnostic tests and treatments suitable for different disorders, setting and monitoring of cost and quality standards, and measuring health outcomes and cost-effectiveness.
• Both Central and State health agencies or their intermediaries will have to develop the capacity for competent purchasing of services from a diverse group of providers.
• The choice of whether to administer NHPS through a trust or an insurance company will be left to individual States.
•   Strengthening primary health services and public hospitals.