Context:

• The National Health Protection Scheme (NHPS) is publicly-funded health insurance schemes, particularly the Rashtriya Swasthya Bima Yojana (RSBY).
• The government has launched this scheme, which is envisions a massive coverage of 50 crore people.
• But the previous experience shows us that merely constituting an insurance scheme will do little to enhance health care.

Previous Insurance schemes in India:

• Any public health insurance scheme would logically enhance medi-care affordability for the masses, which will consequently enhance demand.
• But as Indian public health infrastructure is still in shambles, the supply would have to be met through expansion of private health infrastructure.
• Previously the public insurance schemes like Centre’s ‘Rashtriya Swasthya Bima Yojana’ (RSBY), and Andhra Pradesh’s Aarogyasri had been in operation.
• Both RSBY and Aarogyasri were cashless hospitalisation schemes, but they benfitited few and failed to reach the most vulnerable sections.
• Notably, outpatient care, which accounts for the most of the out-of-pocket spending, wasn’t covered under the scheme.

Challenges Ahead:

• While both targeted people living below the poverty line, over-reliance on private hospitals and poor monitoring watered down their impact.
• This was because; private infrastructure tends to be concentrated in more prosperous regions (increased distances make accessibility tough).
• Some hospitals were found to have performed unnecessary medical procedures on patients, to derive monetary benefits from the schemes.
• Notably, such nefarious designs damage the health parameters and also increase out-of-pocket expenditure (in travel and other accessories).
• The lack of surety of reimbursements has also resulted in some hospitals charging money from the patients despite the insurance cover.

The way forward:

• Considering the poor success of the previous schemes, some have even argued that mere demand oriented interventions by the government are futile.
• Unless the public health systems can compete with the private for funds from insurance scheme, quality healthcare will continue to elude the vulnerable.
• Also, it is important to develop monitoring systems to ensure that private hospitals registered under the scheme comply with the norms prescribed.
• Streamlining reimbursements to hospitals and efforts the expansion of both private and public health facilities at newer geographies are needed.
• Hence, while the NHPS looks massive in terms of coverage, it needs to comprehensively take these factors into account to be successful.

Source:TH