Calls for universal health coverage: Rethink insurance route
By Soham D Bhaduri
The Covid-19 pandemic has exposed the fault lines of Indian healthcare. This has strengthened calls for universal health coverage (UHC) in the country as a long-term reform. In this regard, there seems to be an emerging consensus around expanding coverage through Ayushman Bharat–Pradhan Mantri Jan Aarogya Yojana (AB–PMJAY), which currently insures nearly 50 crore poor citizens for hospitalisation expenses. The High-Level Group on health advising the 15th Finance Commission is looking at it as a medium-term measure.
In 2019, the NITI Aayog endorsed similar vision. Some recent measures like Maharashtra universalising its station health insurance scheme, free Covid-19 testing/ treatment under AB–PMJAY and ‘express empanelment’ to encourage private sector participation in AB–PMJAY, could be a prelude to universalisation of health insurance. Recently, the Director-General of WHO also recognised Covid-19 as an opportunity to speed up Ayushman Bharat with emphasis on primary care.
In ideal conditions, universal health coverage would extend to legions of currently uninsured citizens and lop financial barriers to care, both over a short period. It could also help bring a large chunk of private healthcare under the public ambit, lop informality in healthcare provision, pave the way for better regulation and oversight, and allow monopsonistic power to the state to negotiate for better and affordable care. It may also contribute to reducing regional disparities in healthcare services and fostering the adoption of cost-effective healthcare innovations. We shall now delve into the cons.
A noteworthy finding from the covid-19 pandemic is how the public sector comes in handy during times of crisis. The observation that states with higher per-capita public health spending have tackled Covid-19 better attests to this. It is also important to note that private healthcare interests aren’t particularly aligned with managing infectious diseases and emergencies. Private hospitals view health insurance often prefer high-paying, non-communicable disease-related interventions . The private sector’s sluggish response to Covid-19 under AB–PMJAY till date could be evidence of this.
While the lesson from the pandemic is to strengthen public healthcare, the insurance route to UHC could further weaken the public sector. Private providers would likely comprise an unduely tremendous proportion of empanelled facilities, and public providers, with their weak infrastructure, are bound to lose out. Given the prevailing ethos of encouraging private-public partnership in already decrepit public facilities, the ruin of the public sector would be almost certain.