Page 22 - Insurance Times August 2019

sufficient flexibility built into it so that local administrations Although it is a Rs 5-lakh cover, premium will depend on
can adjust it as per local needs. the average payout. The cost will depend on the
assumptions. The premium that companies would charge
In-patient hospitalization expenditure in India has increased the government would also depend on factors, including
nearly 300% during last ten years. More than 80% of the benefits provided. If maternity, pre-existing diseases and
expenditure are met by out of pocket (OOP). Rural waiting period is waived off, than the pricing will go up. The
households primarily depended on their 'household income pricing would also depend on states' bargaining power of
/savings' (68%) and on 'borrowings' (25%), the urban the states.
households relied much more on their 'income/saving'
(75%) for financing expenditure on hospitalizations, and on India has a major role in driving other countries to achieve
(18%) borrowings. (NSSO 2015). success. Indian success will mean that no country at any
level can say UHC is out of their reach. India has also has a
Out of pocket (OOP) expenditure in India is over 60% which major contribution to make to other countries progress
leads to nearly 6 million families getting into poverty due towards health for all. With commitment to universal health
to catastrophic health expenditures. AB-NHPM will have coverage, strengthening of primary healthcare, provision of
major impact on reduction of Out Of Pocket (OOP) free drugs and diagnostics at public health facilities, and
expenditure on ground of: stepping up financial protection for healthcare through a
i) Increased benefit cover to nearly 40% of the government-funded programme, the scheme proposes to
population, (the poorest & the vulnerable) improve improved access to healthcare and reduce out-of-
ii) Covering almost all secondary and many tertiary pocket expenditure.
hospitalizations. (Except a negative list)
Unless the delivery machinery in healthcare is extensively
iii) Coverage of 5 lakh for each family, (no restriction of overhauled, even the sceptics-approved, tightened version
family size)
of NHPS will remain a strategy on paper that will hit
implementation crisis from the word go. India urgently
This will lead to increase access to quality health and
medication. In addition, the unmet needs of the population needs a robust policy to expand and standardize production
of trained health workers. This will entail creating more jobs,
which remained hidden due to lack of financial resources and ensuring consistent supply to fill these jobs. Opening
will be catered to. This will lead to timely treatments,
improvements in health outcomes, patient satisfaction, new centres of medical excellence, and increasing seats for
admission is not enough.
improvement in productivity and efficiency, job creation
thus leading to improvement in quality of life. Tracking the
The incentive structure of public health workers must be
NHPS will be extremely important to set priorities and shape
future health policies in India. reframed to become competitive, to retain them within
public institutes, and within India. The prestige and respect
attached with the profession must be replenished to attract
In a large and diversified country, health needs differ from
state to state, and, within a state, can vary greatly from one
district to another. Good disaggregated measures of health
outcomes will become the basis of framing and assessing
future health policy. In spite of the best efforts of previous
governments, there is little or no evidence on whether past
health policies have had the intended effects.

A well run NHPS has the potential to become the
cornerstone of India's healthcare needs for several future
generations. As per an actuarial estimate, Ayushman Bharat
Scheme for the poor, would require as much as Rs 20,000
crore in the first year with the number rising to Rs 50,000
crore in later years given the extent of coverage. One
premium will lead to cross-subsidisation. Enforcing exclusion
will be difficult.

22 The Insurance Times, August 2019