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LATEST NEWS UPDATES | Making health insurance work -K Srinath Reddy

Making health insurance work -K Srinath Reddy

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published Published on Feb 6, 2018   modified Modified on Feb 6, 2018
-The Hindu

The National Health Protection Scheme is disconnected from primary care. It also needs to be scaled up

It is unusual for a health programme to become the most prominent feature of a Union Budget. The previous government missed the bus when it failed to implement the recommendations of the High-Level Expert Group on Universal Health Coverage (2011). Yet, those recommendations resonate in the Budget of 2018, with commitment to universal health coverage, strengthening of primary health care (especially at the sub-centre level), linking new medical colleges to upgraded district hospitals, provision of free drugs and diagnostics at public health facilities, and stepping up financial protection for health care through a government-funded programme that merges Central and State health insurance schemes.

Whatever be the time and resources needed to fully implement these initiatives, the Budget sends a strong message that health is now in the spotlight of politically attractive policy pronouncements. From now on, no government can ignore people’s legitimate aspiration to get the health services they desire and deserve. However, health care is not just a matter of health insurance, involving as it does many other elements such as the availability of a multi-layered, multi-skilled health workforce. Further, there is health beyond health care, dependent on many social determinants.

The NHPS, operationally

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. 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. This calls for a 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. Otherwise, hospitals may undertake unnecessary tests and treatments to tap the generous coverage. The choice of whether to administer NHPS through a trust or an insurance company will be left to individual States.

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The Hindu, 6 February, 2018, http://www.thehindu.com/opinion/op-ed/making-health-insurance-work/article22661666.ece?homepage=true


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