By Nitya Chakraborty
The Congress manifesto for 2019 Lok Sabha elections, released by the Party President Rahul Gandhi on Tuesday has many positive features with potential for transforming the lives of the common Indians, but the programmes for healthcare and the senior citizens have policies which really can act as a game changer in bringing about radical improvement in the medicare facilities for all citizens of the country. The Congress scheme is on the lines of the Obamacare and the basic difference of this Congress programme with the current Ayushman Bharat scheme of the Prime Minister Narendra Modi is that the Congress scheme is of universal health care and based on public hospital services as against the insurance companies based programme of the Modi regime.
The manifesto promises to enact the right to healthcare act that will guarantee to every citizen the right to healthcare services including free diagnostics, out patient care, medicines and hospitalisation through a network of public hospitals and enlisted private hospitals. The manifesto mentions that the insurance based model can not be the preferred model to provide universal healthcare in a developing country like India. Only free publi9c hospital model can ensure universal healthcare.
This shift is a positive one and it is achievable. The scheme is far more beneficial to the common people than the Prime Minister’s present scheme which is supposed to cover 10 crore families that is 50 crore people with a coverage of Rs. 5 lakh for secondary and tertiary hospitalization care. With India’s population estimated at around 130 crore, about 80 crore people will be kept out of the Prime Minister’s present scheme which he claims as the biggest health insurance scheme in the world. The fact is that very few of the 80 crore left are having the financial capacity to bear the cost of the high medical expenses on their own.
The income limit for households for qualifying as a beneficiary under the BPL (below poverty line) list is at about Rs. 27,000 per annum. A household with annual earnings of more than Rs. 27,000 will stand excluded from the BPL list. The upper limit has been arrived at by allowing five earning persons in a household with a per capita monthly income of about Rs. 447/- per month in the rural areas, which works out roughly to Rs. 2,250 per month per household. This is too meager an income to meet basic needs for a healthy life. Large number of our population are thus little above this level who are unable to support their basic healthcare needs who would be devoid of any benefit of the Ayushman Bharat.
Since the scheme will cover only the hospitalized patients and not the outpatient care or the preventive healthcare, it does nowhere meet the criteria of comprehensive universal health care. Nearly eighty per cent of the time, the out-of-pocket expenditure of patients is on outpatient care which is not covered under NHPS. It is also not clear whether post hospitalization expenses will be met with by the insurance companies or by the patient. In many diseases, post hospitalization care is very expensive and lifelong.
Senior citizens are the most vulnerable population who need continuous care and empathy. Most of the diseases that occur at this age are chronic in nature, which demand repeated visits to doctors. At a time when the earnings have come down substantially or have become nil, it becomes difficult for the senior citizens to bear with. In the absence of coverage of OPD care, even those who will be enrolled in the NHPS, will not benefit much. Elderly have special nutritional needs which need to be fulfilled. In the Ayushman Bharat there is no such mention of these requirements.
The social determinants of health like supply of clean drinking water, adequate sanitation system, proper housing, nutrition and sufficient wages to meet these day to day needs and health education are the primary factors related to healthcare. However these determinants are not integrated in government’s policy making in practice.
According to the experts, it is well known that the insurance companies’ primary motive is to earn profit. It is presumed that since the number of insured in the NHPS will be very large and as at any given time very few people are hospitalized, this will give enough scope to the companies to reap profits. But if at any stage the companies find it to be unviable, they would not hesitate to pull out on one excuse or the other. If the premium is low then many of them may not join the scheme at all.
Those not covered under the scheme will be left to the mercy of insurance companies whose coverage is premium based. More the premium, more the coverage! The premiums have become very high and out of reach of most of our population. For example a family of five with three senior citizens has to shelve around one lakh rupees annually as premium to get a coverage of 5 Lakh rupees even in the public sector insurance companies. This is impossible for most of those uncovered under NHPS.
As against all these low coverage and uncertainties regarding role of the private insurance companies, the Congress manifesto has clear guidelines about covering all the people under its medicare for all scheme. This has been the demand of the public health campaigners for years and in a country like India with such high level of the people below the poverty line, there is every scope of the private insurance companies fleecing the patients as also the hospital authorities. The Congress scheme has no scope for such developments since the stress is on the public hospitals and full coordination with the state governments in running efficiently the public health centres.
The Congress manifesto has promised to implement a programme that will enable the state governments to revamp and renovate the primary health centres in the states. This will be a case of perfect coordination between the centre and the states which is of paramount importance in providing a decent healthcare to the citizens in every nook and corner of the country. Providing healthcare is a shared responsibility of the states and the centre and the Congress manifesto has set a good example for the basis of such collaboration.