Get cracking: on implementing 'Modicare'

The Centre must draw up an implementation (execution /carrying out-कार्यान्वयन) roadmap for the new health scheme

The NDA government lost precious(costly/valuable-कीमती) time in its first three years in initiating (begin/ commence-आरंभ) a health scheme that serves(work for) the twin purposes of achieving universal coverage and saving people from high health care costs. It announced two years ago in the Budget a health protection scheme offering a cover of ₹1 lakh per family, but ultimately that did not extend beyond ₹30,000. Fresh hopes have been raised with the announcement of Ayushman Bharat in Budget 2018. The plan has the components(section/part-अंग) of opening health centres for diagnostics(treatment), care and distribution of essential drugs as envisaged (imagine/ contemplate-परिकल्पना) in the National Health Policy, and a National Health Protection Scheme (NHPS) to provide a cover of up to ₹5 lakh each for 10 crore poor and vulnerable(weak/feeble-कमज़ोर) families for hospitalisation. These are challenging goals, given the fragmented (fracture/ break up-खंडित) nature of India’s health system. Some States already purchase health cover for the poor, but do not regulate private secondary and tertiary care services or treatment costs. The task before the Centre, which has provided ₹3,200 crore for the programme areas, is to now draw up an implementation roadmap(strategy/plan).

Developing countries that launched universal health coverage schemes over a decade ago, such as Mexico, had to address some key challenges. These included transfer of resources to provinces(territory/region-प्रांत), recruitment of health personnel, and purchase and distribution of medicines to the chosen units. All these apply to India. Moreover, the steady growth of a for-profit tertiary care sector poses(present/constitute-बनाना) the additional challenge of arriving at a basic care package for those who are covered by the NHPS, at appropriate costs. A national health system will also have to subsume(congregate/collect-एकत्रित) all existing state-funded insurance schemes. This will give beneficiaries access not just within a particular State but across the country to impaneled(enlist/enroll-सूची में रखना) hospitals. In the case of the local health centres that are planned under the Ayushman Bharat programme, there is tremendous(immense/enormous-भयानक) potential (capability/capacity-क्षमता) to play a preventive role by reducing the incidence and impact(effect/influence-प्रभाव) of non-communicable diseases such as diabetes and hypertension. 

Such centres can dispense(distribute/allocate-बांटना) free essential medication(treatment/cure-इलाज) prescribed by all registered doctors and procured(obtain/acquire-प्राप्त) through a centralised agency. But the efficiency of a large-scale health system depends on strict regulation. The early experience with state-funded insurance for the poor shows that some private hospitals may resort(shelter/asylum-आश्रय) to unnecessary tests and treatments to inflate(hike / escalate-उठाना) claims(assertion/avow-दावों). Determination of treatment costs by the government is therefore important. This will also aid(help) those with private health insurance, since it eliminates(remove/eradicate-हटाना) information asymmetry and provides a comparison point. The Centre must share details of the next steps.