The big promise on healthcare actually came in 2017 when Narendra Modi announced the National Health Policy (NHP) which aims to double the government’s spending on healthcare from the existing 1.15% of GDP to 2.5% by 2025. However, Finance Minister Arun Jaitley, in the Union Budget 2018, announced two major initiatives under the Ayushman Bharat Programme with a budgetary allocation of Rs 52,800 crore for health in 2018-19, which is only 5% higher than the revised estimate of Rs 50,079 crore in 2017-18. Moreover, it becomes negligible if the figure is adjusted for inflation. It is estimated that to meet the objectives of NHP, the central government health budget alone should increase at least 20% every year.
The first major announcement for the health budget 2018 was that the government is going to establish 1.5 lakh Health and Wellness Centres as the foundation of India’s health system. However, the allocation for these is Rs 1,200 crore, which amounts to only Rs 80,000 per sub-centre. Arun Jaitley also invited the contributions of the private sector through CSR and philanthropic institutions in adopting these centres. The situation of the existing sub-centres right now is rather poor, with inadequate infrastructure and under-staffing. Around 20% of them do not have regular water supply and 23% do not have electricity. Over 6,000 sub-centres do not have an auxiliary nurse midwife (ANM)/health worker (female) while almost one lakh centres do not have a health worker (male), and 4,243 centres don’t have either.
The second big announcement of the health budget is the National Health Protection Scheme (insurance scheme), dubbed as Modicare. “(It will) cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalisation”, Jaitley announced and claimed this to be the ‘world’s largest government funded healthcare program’. However, China’s comprehensive health insurance programme covers an even larger population, though ineffectively, and almost all industrialised nations with the exception of the United States have universal healthcare schemes or national health insurance programs with 100% coverage.
Similar schemes were announced earlier also. There was Rashtriya Swasthya Bima Yojana (RSBY), later renamed as Rashtriya Swasthya Suraksha Yojana (RSSY), and then the National Healthcare Protection Scheme (NHPS) as a repackaged version of all these. Even at state level there are similar schemes for the poor. For instance, Aarograshri in Andhra Pradesh, Vajpayee Arogyashree in Karnataka, Bhamashah Swasthya Bima Yojana in Rajasthan, Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) in Maharashtra, Deen Dayal Swasthya Seva Yojana in Goa among others. The current plan is a magnified form of all these and is far bigger than its predecessors. While RSBY/RSSY promised Rs 30,000 cover per insured, the NHPS increased it to one lakh, and now, under the latest plan, the insured amount is five lakh. But how exactly will this be implemented? The answer is: “adequate funds will be provided for smooth implementation of this program”.
Not even 50% of the funds under the existing health cover schemes have been spent in the past years. Even if the allocation is made, does the public health system possess the necessary infrastructure to support the plan? In that case, this new scheme might be a gateway to a greater role given to private insurance providers and hospitals. An article in Lancet in June 2016 showed that in RSBY, more than 80% of the reimbursements went to the private sector. Out of 7,226 hospitals empanelled by the government for RSBY, more than half of them (4,291) were private. There are enough reasons to believe that the proposed schemes will lead to a significant increase in profits for the private healthcare industry, which is perhaps its intention. Finally, it could help corporate healthcare providers consolidate, at the cost of more affordable smaller providers and enterprises. With the health insurance schemes, the public attention is being diverted from the actual public demand of universal healthcare at free of cost without discrimination.