Promoting Private For-Profit Healthcare

The demand for right to health is being dealt with by the provision of health insurance in India. It is believed in official circles that universal healthcare can be provided merely through insurance coverage for hospitalisation. At the same time, the only thing that could ensure the provisioning of healthcare, particularly for the poor in this country—a functional public healthcare service—continues to be inadequately funded and, thus, systemically weakened. The finance minister, in the last full budget of the present government, made a pitch to focus on health. His tall talk about “Ayushman Bharat,” however, was not matched with any increase in budgetary allocations to the health sector. The budgetary allocation for the Ministry of Health and Family Welfare is at₹54,600 crore compared to last year’s expenditure of₹53,294 crore, an effective decline in real terms if one were to factor in expected inflation. These allocations are nowhere near the prescribed expenditure of at least 1% of gross domestic product (GDP) by the centre and 1.5% of GDP by the states for health. This is the minimum required for a country to provide essential health services, as has been pointed out by several government committees and councils, and prescribed in the National Health Policy 2017.

In keeping with his tall talk, the finance minister announced a “flagship” programme, the National Health Protection Scheme (NHPS), that he claimed would be the “world’s largest government-funded healthcare programme” for 10 crore poor and vulner­able families. This would provide publicly funded insurance coverage of₹5 lakh per family for hospitalisation. While the speech promises that “adequate” funds will be provided for its smooth implementation, this is not reflected in the budget documents. Even with a modest estimate of₹3,000 per household to be paid as premium per year, for a cover of₹5 lakh, the budget required would be₹30,000 crore. The existing healthcare insurance scheme, Rashtriya Swasthya Bima Yojana (RSBY), that provides an annual coverage of₹30,000 to poor families has been allocated only₹2,000 crore in the 2018–19 Union Budget. Later statements by officials from the health ministry, finance ministry, and Niti Aayog clearly show that there is a small likelihood that the NHPS will even take off this year.