Proposed health insurance will not benefit poor patients
The Proposed National Health Insurance for 10 Crore /100 million poor families which would cover almost 50 Crores people/500 million or 40% of the population looks a good measure to make heath care accessible to such a large segment of the population. While there is cheer all around about health policy measures announced by the Modi Govt – however a closer look at the overall public Heath situation makes these budgetary announcements diversionary, particularly when Core issues like Capacity & Service Delivery remain largely unaddressed. It is important to note is that the overall fund allocation for Health Care in the present budget has remain unchanged or rather decreased marginally, the proposed NHPS 2018 is likely to be funded from the exisisting public health care budget which would mean lesser funds available and this would mean that very little will be done to improve both capacity and service delivery in the existing public health system.
Successive governments have failed to focus their health policy on improving capacity and service delivery in public health care either due to lack of vision or simply because it is not politically appeasing. While it is well established that India has the lowest Doctor to Patient ration (0.76) per 1000 population - A closer look at some other bottle necks in the public health system that need urgent attention are to improve Capacity & Service delivery model across primary, secondary & territiary care.
High Waiting Time & long Queues
Back home in Telangana a poor patient who access health facilities in the territiary care has to spend a minimum 3 hours for obtaining OP Registration, consulting a doctor and procuring medicine which is prescribed from the state run hospital, needless to say this is bcoz of the huge daily load on the system and the failure of the govt to expand capacity both in terms of doctors/paramedics/patient care givers and infrastructure.
A Cancer patient visiting the State run Cancer Hospital in TS spends at an average 4 hours right from OP – Consultation – Pharmacy due to similar issues. A patient in secondary care level spends at an average 2 – 3 hours from OP – Pharmacy and this situation has not changed over years and has been neglected and infact is getting worse. A pregnant women in secondary care spends at an average 2 to 3 hour for a Ultra Sound Scan due to lack of machines and over load – Pregnant women in districts spend an entire day in travelling for a ante- natal check up in primary health care facility in the district. For a majority of the people who access public health care not out of choice but due to their weak economic background this means that there is not only loss of wages due to long hours spent but also misery for having to wait long hours to get access to health care and consequently they lose trust in the public health delivery.
On the capacity side the situation is no better, shortage of beds, doctors, nurses, investigations, medicines, equipment add to the misery of patients in the public health care. Some of the issues that I can recall on top of mind are - In the entire state of TS there is no PET Scan machine, which is required by Cancer patients as a key diagnostic tool to check the spread of the disease and each whole body PET Scan cost 12000 – 20000 at an average in private, Advanced Cancer Chemo Drugs are not available in the Govt Cancer Hospitals, Post Transplant Medication which needs to be made affordable for hundreds of poor patients who undergo organ transplant, Advanced Implants and prosthesis are not full covered by the state insurance cover, the wait for MRI Scans in territiary hospitals is at an average 2 to 4 months due to shortage of machines and high load, Blood Banks remain dysfunctional and 80% of patients in State Run Hospitals are asked to procure blood from outside, the average waiting time for an elective surgery in ENT like Tonsillitis in the state run ENT Hospital at Koti is 3 to 6 months, there were 3341 ENT surgeries pending as on Aug 2017 ( RTI data), with an average waiting time off 3 to 6 months , because of overload on the system and under capacity ( lack of OTs & doctors). The situation in Primary Health Care is no better 55% of the Urban Primary Health Center in the City of Hyderabad are without doctors.
Although the local Govt has taken several measures to improve facilities at state run hospitals but the onus to further improve both capacity & service delivery in view of tighter budgets from the Central Govt will challenging to say the least.
In conclusion the proposed NHPS, 2018 will need a lot of rules & regulation to be put in place, if justice has to be done for the poor- it would have been good idea if instead of giving funds to Insurance companies the Central Govt funded the ‘state Illness Fund’ & it would be even better if the health coverage is offered to patients for services in public health hospitals only - this would mean that the cash strapped Govt Hospitals at the state level will have access to funds to cover essential medical services which are presently unavailable in these hospitals. Allowing health Insurance coverage to be spent in private health care will only add to the profits of private nursing homes and corporate hospitals and the proposed 5 lac cover will look meagre if the poor use this for availing services in private health care. It is time for Govt health policy makers to re look at the core issues and work out a comprehensive plan for improving both capacity & service at the state run hospitals without which the common man will continue to suffer due to high out of pockets medical expenses incurred in private health care that push nearly 4 – 5 % of the population into poverty each year.
(The author, Mujtaba Hasan Askari is the Managing Trustee of Helping Hand Foundation; the views expressed are his personal)