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Modicare: The way ahead?

India’s ambitious National Health Protection Scheme requires more emphasis on the details than the objectives

Modicare: The way ahead?
One of the most notable announcements of this year's Union budget, the National Health Protection Scheme or 'Modicare' as it has been dubbed, is a potentially game-changing scheme for Indian healthcare. Being billed as the largest state-run health insurance plan in the world, it aims to provide a medical cover of up to Rs Five lakh to 10 crore poor families. Make no mistake, this comprises almost half of the Indian population, making the scale of this plan mighty ambitious.
To understand the need for such an over-arching scheme, it is important to underline that over 80 per cent of India's population is not covered under any health insurance. The National Sample Survey (NSS) data in 2016 found that despite seven years of the Rashtriya Swasthya Bima Yojana (RSBY), only 12 per cent of the urban and 13 per cent of the rural population had access to insurance coverage. It also reported that the biggest challenge in seeking medical treatment was stated to be "financial constraint" by an overwhelming number of both rural and urban Indians. The lack of insurance cover also pushes thousands of Indian families into poverty, every year, owing to healthcare expenditure eating into their meagre savings.
On the face of it, Modicare appears to be manna from heaven for the deprived Indian masses, for whom the access to quality healthcare remains a distant dream. However, the devil, as they say, lies in the details. So, even as the scheme appears right on intent and high on hype, it is still sketchy as far as the details are concerned. For the scheme to be implemented successfully, there are significant challenges before the government, of which funding is just one.
Sources of funding
While the Union budget allocated an initial fund of Rs 2,000 crore to the scheme estimated to cost between Rs 11,000-12,000 crore, there have been conflicting reports since then about how and where the extended allocations would come from. Some reports have suggested that the NITI Aayog is chalking out a model of fund sharing between the Centre and the states to meet the expenses. On the other hand, Finance Minister Arun Jaitley had said in an interview that the funding will be met through the 1 per cent increase in education cess on income tax, and the newly re-imposed long-term capital gains tax. Reports have also suggested that the annual premiums per family have been estimated to cost the government around Rs 1100 to Rs 1200. The figure itself appears inadequate to cover an entire family.
While the exact contours of the scheme's funding will take some time to be made available, the confusion does indicate that the programme hasn't been well thought through. Let's just hope that the NITI Ayog, which is currently believed to be working on the scheme, manages to eke out a smooth plan which can be rolled out at the earliest.
Absence of clarity
Besides the source of resources for the scheme, the plan is also sketchy on other details. What will be the path through which an individual will get admitted for cashless treatment in a medical facility is as of now ambiguous. Will the system function with a third party administrator or a referral system?
We are also yet to know the mechanism through which the private hospitals will be brought onboard the healthcare scheme. What will be the eligibility criteria for hospitals to get empanelled into the scheme and what will be the network group of hospitals slated to provide treatment are crucial questions that still stand unanswered. A series of media reports, in the recent years, have highlighted how the previous government's flagship health scheme Rashtriya Swasthya Bima Yojana has been crippled by problems such as abuse by hospitals and insurers. A crucial question to ask here is how will the government ensure that the same problems do not bedevil the NHPS?
OPD expenses
While hospitalisations happen once in a while, OPD expenses are a constant. Unfortunately, the lack of adequate OPD coverage in the insurance remains a major factor that desists many Indians from buying medical insurance. Modicare, too, appears to have left this major expense out of cover. A major question is whether the Rs Five lakh insurance amount will cover the OPD expenses of the people as well. Consultation, diagnosis and treatment itself consist a significant monetary burden on poor citizens. Many people avoid or delay seeking treatments because public hospitals are dysfunctional and the cost of treatment in private clinics is more than what they can bear. MRI's and CT Scans cost thousands of rupees and even generic medicines seem to be unaffordable for the poor. If the scheme does not cover at least a part of the OPD expenses, its benefits will only be limited.
Prevention plans amiss
A healthcare scheme is incomplete if it focuses only on hospitalisations and treatment while overlooking the tremendous need for disease prevention and early diagnosis. Unlike in the West where diseases such as cancers and heart diseases are detected in the early stages, when a successful life-prolonging treatment is possible, in India, the diagnosis is largely conducted only during advanced stages of the disease. The lack of robust screening modalities in conjugation with the absence of awareness on prevention and disease control are the factors that are responsible for this. Sadly, the ambitious NHPS fails to lend any attention to this aspect.
To sum it up, the healthcare coverage scheme sure sounds hopeful for a large section of the Indian populace. However, there is no clear plan yet to implement it. Unfortunately, in India, many such promising programs have failed the critical test of implementation. The nation will have to wait and watch on how the government is planning to actually implement this gigantic scheme which holds the potential of transforming healthcare delivery for millions of people in India.
(Dr. Dharminder Nagar is Managing Director of Paras Healthcare. The views expressed are strictly personal)

Dharminder Nagar

Dharminder Nagar

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