The Wire article ‘What the Centre’s New Health Insurance Scheme Means for States That Have Their Own’, published February 7, 2018, talks about the recently announced National Health Protection Scheme, or NHPS, and compares it with an insurance programme called the Comprehensive Health Insurance Scheme (CHIS), which is run by the Kerala state government.
The article makes comparisons between the two schemes as per the enumeration of the poor. Further, it questions the insurance-based model to redress the problem of unequal access to health.
COUNTING THE POOR: BPL LIST VS SECC DATA
The Wire article talks about how the NHPS will count its beneficiaries – that is, the poor. The old way of doing so was by means of the BPL list. This is the same list which is used by the Kerala government in its CHIS programme.
Now, there are several issues with the BPL method.
The BPL method is an older method of enumerating the population of the poor. The fact is that there are people who are above the poverty line — families which are not involved in the formal economy – but present wrong information to avail benefits of subsidies and other government schemes, which leads to a huge leakage of government funds. So, such people also end up listed as among the poor by this method. At the same time, use of BPL data can also end up leaving out families which are just above the poverty line but are in need of coverage.
This, in turn, skews the figures for the targeted population which genuinely deserves to be served by the health insurance programme. The logic is simple: if there are problems with the original method and data, each subsequent stage in the use of such method and data would also be faulty.
In contrast, the Socio-Economic Caste Census (SECC) uses a different method for the enumeration process. It does not use household income as a parameter, but exclusionary factors (for example, motorised vehicle) and inclusion criteria, such as households without shelter, manual scavengers, etc among others to count the people who would make it to the list.
SECC data is a more accurate, robust and up-to-date way for the enumeration of the poor. That is why the Central government itself is using the SECC data for many of its schemes, such as Saubhagya, PMAY and now for the NHPS. For the same reason, the Centre has also advised state governments to use the SECC data for their own schemes.
In sum, the BPL method is an absolute method with the line determining who gets the benefit and who does not, while in reality it may not be practical and fair to divide people in need so sharply and absolutely. The SECC method, on the other hand, is more relative, taking account of various criteria, making allowances and also more accurately determining who is in need of help and who is not.
NHPS AND OTHER STATE INSURANCE SCHEMES
The article talks about the Rashtriya Swasthya Bima Yojana (RSBY) that was begun by the UPA government, as well as schemes like the CHIS in Kerala, Tamil Nadu and other similar insurance programmes offered by other state governments.
There can be no comparison between the insurance coverage under NHPS and the above-mentioned schemes. NHPS provides the highest health coverage of Rs 5 lakh per family, per year, and therefore it is the biggest health insurance cover yet — more than what any of these state governments are providing. In contrast, coverage under RSBY and CHIS have amounted to only Rs 30,000 per family.
NEED FOR STATE-SPONSORED HEALTH INSURANCE FOR THE POOR
Policies are not made in a vacuum. There is a need felt by the government, and it addresses it through a policy intervention. The Wire questions the efficacy of insurance as the solution to inequities in access to healthcare, trying to substantiate its claim by saying that it has not worked in some developed nations.
Well, current policies are made with the current state of affairs in mind, which is that the poor incur a high out-of-pocket expenditure due to the preference for private health infrastructure. As of now, most of the population, regardless of means, is heavily dependent on private health services.
New public infrastructure is being built, but it cannot be completed overnight. It is a long-term solution. If most of the population is dependent on expensive private services, the government would need to come to the aid of the poor and take care of their health expenses. And that is what the Centre is doing by NHPS and health insurance, in this sense, is an immediate solution.
Most public infrastructure, new and old, including the 1.5 lakh new health and wellness centres, are already providing/ will be providing free healthcare services. Therefore, health insurance is an additional means to directly and immediately benefit the poor and address their healthcare requirements.
For further details about NHPS and whether it is necessary or not, please read our earlier articles:
Budget 2018: A Fact-Check on Allegations of Neglect of Primary Healthcare & Public Infrastructure
Budget 2018: A Response to the Twin Narratives of “Anti-Middle Class” & “Poor Will Not Benefit”
Budget 2018: The Healthcare Umbrella