BENGALURU: The World Health Organisation’s foundation is celebrated as World Health Day every year with a theme. As it turns 70 on April 7, the theme this year is ‘Universal Health Coverage: Everyone, Everywhere’. Since, Karnataka is the only state in India to have supposedly offered Universal Health Coverage (UHC), heads of WHO-India, representatives from UNICEF, Suvarna Arogya Suraksha Trust (SAST), Public Health Foundation of India, NGOs and public health experts from the state health department converged in Bengaluru on Friday to discuss what the universal health coverage is all about.
SAST (the implementing agency of Arogya Karnataka, the state’s flagship UHC scheme) officials assured that insurance companies will not go out of business in the state as Arogya Karnataka does not cover everything.
“Insurance companies, which is a multi-crore business, is feeling threatened in the state.We have limited packages. Since APL patients pay 70% of the procedure cost, and only 30% is paid by the government, insurance companies can offer a top-up policy,” said Dr Sudha Chandrashekar, director of medical management in SAST.
“Making that 70% component cashless can be a focus of insurance companies. AK covers only emergency for 48 hours and since, polytrauma cases need more than that, insurance companies still have a role to play in accident coverage and trauma cases. Also, we are not covering patients if they travel outside Karnataka. So, the insurance companies can work on portability of insurance,” she said.
At present, AK is available only in 10 government tertiary care hospitals in the state. The government has set itself a deadline of December 31 for the scheme to expand to all the 33 district hospitals, taluk hospitals, primary health centres and community health centres. It is unclear how many private hospitals are willing to be empanelled in Arogya Bhagya.
The government order on AK also makes it clear that any patient without a referral from a government hospital, except in case of an emergency, will have to bear the cost of the treatment and no reimbursement will be provided for such treatment. The government has no mechanisms in place to determine fraud and corruption as a nexus between corporate hospitals, and government doctors can easily take place for obtaining referrals, said a public health expert.
WHAT ABOUT AYUSHMAN BHARAT?
“We have written to the union government that we will go ahead with Ayushman Bharat (National Health Protection Scheme) also in an ‘assurance’ mode,” said Chandrashekar. This means that the state government is not keen on relying on a third-party administrator, as in an insurance company, to roll out NHPS.It will roll it out along the lines of AK where SAST is handling it on behalf of the government.
What UHC is not, according to WHO
UHC does not mean free coverage for all possible health interventions, regardless of cost, as no country can provide all services free of charge on a sustainable basis
UHC is not only about individual treatment services, but also includes population-based services such as public health campaigns, adding fluoride to water, controlling mosquito breeding grounds, etc