The Indian Express article ‘Union Budget 2018: Poor diagnosis, wrong medicine’, published January 3, 2018 and written by Sourindra Mohan Ghosh, Imrana Qadeer of JNU, talks about the healthcare programmes and reforms announced in the Union Budget — and alleges that the expenditure on the health sector is inadequate.
The article also says that the newly announced Ayushman Bharat programme is a case of shifting focus from primary healthcare to tertiary care. The apparent reason cited is that insurance as a substitute for public infrastructure can be counter-productive.
Let us, therefore, analyse the concerns raised by the writers.
UNDERSTANDING THE AYUSHMAN BHARAT PROGRAMME
The Ayushman Bharat programme has two major initiatives under its aegis:
- Health and Wellness Centres: With the allocation of Rs 1,200 crore, 1.5 lakh centres will come up across India, which will provide healthcare facilities for non-communicable diseases and maternal and child health services, which includes free essential drugs and diagnostic services.
- National Health Protection Scheme (NHPS): This programme is aimed at benefitting 10 crore poor and vulnerable families and 50 crore individuals by providing insurance of Rs 5 lakh per family, per year for secondary and tertiary care hospitalisation.
It is perhaps curious to see that despite the fact that the biggest state-funded healthcare programme in the world has just been announced in India, some media outlets and commentators are persisting in alleging a fall in healthcare expenditure.
DEATH KNELL FOR PRIMARY HEALTHCARE & PUBLIC INFRASTRUCTURE?
Undoubtedly, the NHPS is one of the biggest healthcare programmes ever announced. Why then would commentators and critics seem blind to the NHPS’ coverage and fail to acknowledge the provision of health and wellness centres? In fact, addressing primary healthcare appears to be precisely the reason why the scheme has been launched.
24 new government medical colleges and hospitals are going to be set up, with at least 1 medical college for every 3 parliamentary constituencies and at least 1 government medical college in each state.
Do these provisions not cater to, provide for and contribute to primary healthcare and public infrastructure?
The free essential drugs and diagnostic services which will be provided at health centres and the establishment of these very health centres, as well as the new medical colleges, are very much part of the primary healthcare and public infrastructure that the writers talk about.
RATIONALE BEHIND PUBLICLY FINANCED HEALTH INSURANCE
The Indian Express article questiones the apparent neglect of the healthcare sector and public health. It also alleges that there is a substitution through publicly financed health insurance.
The article seems to be stuck in a binary. The above expenditure on health centres and establishment of new medical colleges shows that the government is spending on public infrastructure.
At the same time, the government is also spending on publicly financed health insurance on such a large scale for the first time.
When the piece itself talks about the huge out-of-pocket expenditure by the poor — and then does not acknowledge the fact that the very issue has been completely addressed — it seems that the writers’ complaint was pre-determined and made for its own sake.
Finally, why are secondary and tertiary healthcare receiving such an impetus? The reason lies in the cost of these services, which tends to be far bigger. The government has intervened and provided relief to 10 crore poor families by taking over the burden of these services.
Does public infrastructure need a boost? Sure, it does. But while public infrastructure is improved to better standards and bring in long-term benefits, it also takes time to build. What then is the immediate solution to a high out-of-pocket expenditure by the poor? The answer seems to be insurance — a fairly big health insurance cover. And that is just what the government has provided.