The World's Largest NHS

India will get the world’s largest government funded national health programme, according to the Budget announced by finance minister Arun Jaitley. The mega health insurance scheme for the poor will give the sector a big boost but could cost over ₹1 lakh crore, according to some independent estimates. Based on the cost of the existing Rashtriya Swasthya Bima Yojana, back of the envelope calculations show it would require ₹30,000 crore The National Health Protection Scheme will provide 100 million families with medical coverage of up to ₹5 lakh per year for secondary and tertiary care hospitalisation.

RSBY provides ₹30,000 cover for up to five members of a below the poverty line family. The Centre provides 75% of the total premium while states pay the rest. Around 36 million of 59 million BPL families across 15 states are enrolled in the RSBY scheme.

The allocation for RSBY rose to ₹2,000 crore in FY19 from ₹470.52 crore in FY18. Given that the cover under NHPS is ₹5 lakh and the coverage is more, the ₹470.52 crore spent in FY18 topped up with 25% provided by states, when proportionality increased yields about ₹30,000 crore cost.

Former finance minister P Chidambaram said, “If the insurance companies will foot the bill, the premium at ₹5,000-15,000 per family will require an outgo of ₹50,000-150,000 crore per year. Is the FM serious?”

“The scheme announced would mean the government would be required to spend at least ₹1.2 lakh crore in premiums to private health insurance firms to extend coverage to 50 crore people,” health economist Indranil Mukhopadhyay said.

The government has not yet made any allocations for the scheme. “Adequate funds will be provided for smooth implementation of this programme,” Jaitley said.

Healthcare providers welcomed the scheme. “This will be a big boost for us. The current insurance schemes were unviable, but with the increase in cover, I think we will see a growth in our state-sponsored scheme patients,” said Suneeta Reddy, MD, Apollo Hospitals Enterprise.

Another challenge would be lack of adequate hospitals, doctors and diagnostic laboratories, especially in north Indian states.

A good healthcare delivery system providing services of reasonable quality is necessary for people to take advantage of this scheme, said former health secretary K Sujatha Rao. “The government will either have to raise public investment to strengthen its own service delivery system or incentivise the private sector by providing the necessary market,” she said.

Ankur Nijhawan, CEO of AXA France VIE (India Reinsurance Branch), said the defects in RSBY should have been addressed. “Government should focus on creating reasonable package rates, fraud mitigation and beneficiary grievance while addressing the flaws of RSBY such as smartcard misuse, enrolment flaws and delay in premium,” he said.

The government has allocated ₹1,200 crore towards 150,000 health and wellness centres envisioned in the National Health Policy 2017 to provide comprehensive healthcare.

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