“Modi Care” -World’s Largest Government Funded Public Health Coverage.

A mega healthcare project, touted by experts as world’s largest healthcare scheme was unveiled by Finance Minister Arun Jaitley during the presentation of Union Budget on February 1st this year. It is the largest in terms of both its expanse and expense. The scheme is christened National Health Protection Scheme (NHPS) and aimed at providing healthcare insurance to 100 million families. The insurance maximum has been pushed to Rs. 5 lakh per family.

This magnanimous project, nicknamed ‘Modicare’ by Arun Jaitley targets the financially weaker section of India, which accounts for about 41.3% of the population as per Census data. Through this scheme, the government aims to reach out to about 500 million individuals and ensure that atleast 4 in 10 individuals can obtain secondary and tertiary medical care within the insurance limits. Secondary healthcare comprises of skilled medical services by medical practitiners including brief hospital admissions for a slightly serious illness while tertiary healthcare includes more serious and longer illnesses, including terminal illnesses that require specialized treatments. Healthcare services will be available in government and private hospitals within the insurance cover.

The Centre aims at stationing national health agencies in every state to oversee the implementation of the scheme. An important factor is primarily, the identification of true beneficiaries that belong to lower socio-economic section of the society as per the 2011 census.

The NHPS budget, calculated as per current expenses in healthcare sector, has been outlined to be an ambitious amount of over Rs. 1 lac crores. While questions are being raised over feasibility of implementation of the scheme in the backdrop of the failed implementation 2016 Union Budget that aimed at providing Rs. 1 lac health insurance cover per family, the government is quite optimistic over this herculean task.

The current healthcare scheme, Rashtriya Swasthya Bima Yojana (RSBY), which provides a Rs. 30,000 medical insurance cover per family, has successfully been implemented in 15 states for the Below Poverty Line (BPL) families. In this scheme, out of the corpus earmarked in the budget, Centre shells out 75% of the expense while the States pay the rest. The proposed ‘Modicare’ scheme is inspired by the Affordable Care Act successfully implemented by Barack Obama in the United States and shares its blueprint with the same. It aims at increasing the current insurance cover of Rs. 30,000 per family by 1500% to Rs. 5 lac per family. The contribution and share of State government has so far not been elucidated in the budget document clearly.

As a backing to the NHPS, the Centre also proposes to introduce about 1.5 lac health and wellness centres under Ayushman Bharat Program for providing primary care and treatment for non-communicable diseases. These primary care centres will also provide necessary medical facilities to new mothers and children. Provisions may also be made for disbursal of free essential medications and tests and diagnostic kits to these centres.

To meet the greater demand of healthcare services in near future, setting up of more number of government medical colleges and hospitals such that there is at least one college for three parliamentary constituencies, is also in the pipeline. The bird eye view of current situation shows unequal distribution of government medical colleges affiliated to Medical Council of India (MCI) although the numbers may be an impressive 479 medical colleges for 543 parliamentary constituencies. It has been observed that the medical colleges are more densely populated around urban regions than in the rural areas.

The doctor to citizen ratio in India is also highly skewed with only about 80 doctors per one lack Indian citizens. According to a report by World Health Organization (WHO) titled The Health Workforce in India, this number is really low and unevenly distributed throughout the country. While Chandigarh has about 280 doctors per lac population, Meghalaya has only 28. It has also been observed that the north-eastern states lag way behind in the healthcare sector and in the number of health professionals. Nagaland and Arunachal Pradesh too have only 35.6 and 32.5 doctors per lac population. The proposed increase in medical colleges may help in increasing the number of trained healthcare professionals and doctors in general.

India’s low per capita expenditure at constant PPP (Purchasing Power Parity) too is in question. The PPP is calculated by seeing the net expenditure on any commodity after accounting for the exchange rate and normalizing it. The per capita expenditure on healthcare in India is way lesser than even other developing countries like Gabon, Djibouti in Africa and Indonesia. India’s health expenditure per capita was about $267 in 2014 as against the world average of $1271 as per World Bank data. This figure itself speaks for the lower income levels and price of healthcare in the country. Developed countries aim to invest more in the health of citizens and thus move towards a more economically equal society.

The scheme also aims at improving India’s ranking in following a universal healthcare cover and schemes and improving citizens’ financial freedom. It currently ranks 130 out of 180 participating countries in the Heritage Index of Economic Freedom 2018, which ranks the financial freedom of citizens. The top ten nations in the list were bound by a common factor of having universal healthcare schemes and included Hong Kong, Singapore, Switzerland, Canada, Denmark amongst others.