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Budget's health care – Mere hype or old wine in new bottle?

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Budgets health care – Mere hype or old wine in new bottle?
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In post-budget debates, one thing that stands out (at least going by media focus) is Jaitley's flagship announcement of a health care supposed to benefit 50 crore of the population which he described as "the world's largest government funded health care programme". The tendency of the BJP party circles to tout it as "Modi-care' (on the lines of Obamacare of the US) also may make it appear as a poll propaganda tool.

The package is to benefit 10 crore "poor and vulnerable families (approximately 50 crore beneficiaries)" with an allocation of Rs 5 lakh per family. This is basically a health insurance scheme in which the government foots the bill for insurance premium of the targeted segment. But the budgetary provision is a mere Rs 2000 crore. (In fact para 59 of the budget speech states only that "adequate funds will be provided for smooth implementation of this programme" which has triggered criticism that it is a declaration without a clear blue print or adequate allocation.)

In the 2017-18 budget, the government had announced a National Health Protection (NHPS) with a cover of Rs 1 lac for a family. That scheme had not taken off, and the government did tell the parliament just two months ago that "the contours of the scheme are yet to be finalized" which minus the verbiage would mean it could not be properly implemented. Now when even that smaller scale scheme could not take off, the government has gone ahead with this increase from Rs 1 lac to Rs 5 lac per family.

Another feature of this scheme is that instead of strengthening public health care facilities, it is likely to benefit the private insurance companies more. As former finance secretary Arvind Mayaram pointed out in a tweet "Universal health insurance through private hospitals has not worked for the poor anywhere. Biggest beneficiaries are the private hospitals and insurance companies. There is no substitute for public health care. More money should have been pumped to strengthen it."

This and other initiatives declared under the ‘‘Ayushman Bharat’’ programme are similar to, or reincarnations of schemes launched earlier. In fact the UPA government had introduced a health insurance scheme which may be the old wine in this 2018 bottle. The government’s new programme is the fourth edition of the Rashtriya Swasthya Bima Yojana (RSBY). In 2016-2017, RSBY was renamed the Rashtriya Swasthya Suraksha Yojana (RSSY) which again reappeared as National Health Protection Scheme (NHPS) in 2017-2018

The NHPS had agreed to provide Rs 1 lakh per family. The RSBY offered Rs 30,000 to poor families which Jaitley mentioned in his speech.

The scheme in its present form announced is massive both in reach and total bill. The major benefiting feature of the scheme may be the raise in limit per family of Rs 5 lakh. But again Rs 5 lakh per family will come to cost around 17 times the RSBY scheme and will cover 40% of India’s population. The earlier version RSBY had targeted to cover 5.9 crore, but managed to include only 3.6 crore. As such 10 crore people has is likely to remain more hype than achievement.

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