NEW DELHI: As the Centre started trials of its mega healthcare insurance scheme on Wednesday, public health experts expressed concerns regarding the implementation of the programme of such a large scale.
Public health experts and industry insiders say the most crucial question is whether the scheme, which aims to cover about half a billion population, will be economically sustainable. “It is good that a major initiative has been started to reduce out-of-pocket expenditures that force millions of families towards catastrophic healthcare spending every year, but there are numerous obstacles that need to be overcome,” said S Srinivasan of Low-Cost Standard Therapeutics.
At the moment, private hospitals are unhappy because, in their view, package rates fixed by the government are not good enough. For example, the proposed cost of a Caesarean-Section is just about Rs 9,000 whereas the Central Government Health Scheme rate for this in Delhi is Rs 16,000 and even mid-rung hospitals routinely charge up to Rs 1 lakh for the procedure.
“The government is saying the scheme will first be implemented through public hospitals. So, it shows its lack of preparedness,” said Girdhar J Gyani of the Association of Private Healthcare Providers of India. “We were expecting an aggressive launch of this big-ticket scheme, but they have only started trials as of now because required elements are not in place. For a scheme like this, private hospitals should be jumping. But this won’t happen unless a formal costing committee is formed and rates are revised.”
Oommen John of Jeorge Institute of Global Health, a Delhi-based health research institute, said that infrastructure and lack of manpower were major hurdles that the government would likely face.
“There could be a situation, for instance, where a large number of people are turning up for surgeries in a district hospital but there are not enough operation theatres or doctors,” he said. “The government has said that it will rely on public hospitals to roll out the scheme in the first phase, but there is no emphasis on infrastructure strengthening.”
A senior executive with an insurance firm said that insurers are not too happy because most states are opting for ‘Trust’ model that does not require insurers to participate. “Where insurers participate, the auction may push premiums to unviable, low levels. Also, insurer model is overseen by organisational committees, with government representatives, which will be more patient-centric.”
In the Trust system, on the other hand, there is less restraint on claims payment. “Success will depend upon how quickly and comprehensively these are identified and addressed,” said John.