National Health Protection Scheme: Hope Or Hype?

Published: April 13, 2018 19:51 IST
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The National Health Protection Scheme (NHPS) has not only been the high point of the recent budget, but also a shot in the arm for target 'health for all'. While detractors brand it as impractical populist gimmickry, it is exactly what the doctor ordered to rev up the rusty national health engine. Its scale has the potential of transforming the country's health care landscape, and makes a strong case for not dismissing it as "old wine in a new bottle".

For starters, mind-sets about health costs must change. A 2011 study at the (Indian) Institute for Social and Economic Change showed that 21% of the annual income was lost due to ailment, especially among the poor and those with poor amenities, both in urban and rural areas. Simply put, diseases cured are work days gained. This is especially true for India where nearly two-thirds of the population is younger than 40, comprising of the present and future work force. It is time we encash this 'demographic dividend' and consider spending on health as investment rather than expenditure, thus turning this economic 'burden' into prosperity.

Philosophically, the state contributes significantly to all robust health care systems, spending 8% (Denmark) to 18% (USA) of the GDP. So the NHPS is undoubtedly a step in the right direction. The challenge here will not be to find the money, but to connect the insured, the insurer, the state, and the health care provider. That is where digitization and technology need to step in. The government must continue to drive the development of digital infrastructure, get India digitized, and digitally literate. Health data including age, region and season-wise disease trends, need to be fed rapidly into national servers to generate reliable estimates of the needs. Data on reasons for in- and out-patient attendance at primary to quaternary level centers must be collected and stored digitally. Data analytics can partition care into categories that can be given by long distance consultations, mobile apps, mobile units and physical centers. Concurrently, national data on available capacity in the public and private sectors at the four levels of healthcare must be updated, capacity building requirements inferred, and milestones set. All the data collection and storage should be app - and web-based. Digitally literate persons should feed in their own and community data. Additionally, panchayats, schools, health centers and municipal corporations should all be recruited to become data collection hubs. Clearly, the National Digital Health Authority that was launched recently, have their work cut out for them.

Accurate data on health care requirements and capacity alone can calm the storm stirred up by wildly disparate quotes from politicians, insurers and doctors on the premiums to fund the NHPS. Insurance companies must use big data to arrive at balanced formulae that cover a range - basic needs provided online, at mobile units and primary/secondary health centers,to complex procedures at inexpensive higher centers - and yet keep the cost to the exchequer realistic. The tools used for data mining and analysis would logically, lean on artificial intelligence. Devices and software for instant machine-based diagnoses, telemedicine, remote diagnostics and mobile units are logarithmically cheaper and logistically less formidable than physical treatment at a static point of care, and should be employed extensively. This new ecosystem needed to get the 'health for all' juggernaut on the road promises to generate a goldmine of opportunities in technical innovation for both, the tech geeks and the giants alike.

The health needs of a nation stretch way beyond mere health insurance. The NHPS should be at the core of a systematically rehashed global health policy. Rather than re-invent the wheel, lessons must be drawn from working systems elsewhere, such as the UK, Scandinavia and Brazil. The latter, a close demographic and economic mimic of India, has turned national health around with state insurance resting on the four pillars of incremental budgetary allocation, a strong culture of preventive medicine, a comprehensive network of family practitioners, and recruiting municipalities in dispensing health care.

Wide participation in building the national health program among individuals, insurers and private health entities must be spurred on through carefully crafted subsidies and disincentives. Public private partnerships should be forged for optimal resource utilization. Previous attempts at involving private institutions in healthcare at the grass root level have been impractical and lack accountability. Consider the oft lamented case of thousands of private hospitals built on subsidized land, sidestepping their commitment towards free treatment of the poor. This policy is inherently flawed. 'Free' treatment for anything but the smallest of maladies is simply unsustainable. It achieves little beyond treating cronies of people in power, falsification of records and bribing of health inspectors. Shutting down these centers would only bump up the healthcare access deficit, and be counter-productive. Instead, their responsibilities should be made more tangible and easy to audit, by mandating their participation in community health and prevention programs, running mobile units and telemedicine facilities for a defined catchment area, accepting NHPS funded patients, and a cess towards national health care costs.

As the scheme enhances healthcare affordability, a staggering half a billion additional heads are poised to suddenly fall within the ambit of insurers and providers. Insurance companies as well as large private healthcare groups must seize this opportunity and extend their footprint to tier 2 and 3 cities, as well as rural clusters. This will open up the flood gates to investments in 'no-frills but functional' healthcare units in these areas, and generate additional employment and revenue.

India's journey to keep every Indian healthy has only just begun. This new willingness to look up the steep climb from the current 1.4% of GDP spend on health to an average of 10% in the developed world, is exciting. Team Modi now need to back their fervid budget pitch with swift action on the ground, using policy and technology as crutches.

(Dr. Arvinder Singh Soin is a pioneer liver transplant surgeon and medical innovator.)

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

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