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Jan Swasthya Abhiyan (JSA) and several other health network organisations on February 25, 2019, asked the Centre to invest more in public healthcare while rolling back its flagship health insurance scheme, the Pradhan Mantri Jan Arogya Yojana (PMJAY).
JSA members were speaking on the occasion of the launch of their health manifesto.
Citing a study of the Institute of Economic Growth, the members said PMJAY may subsume 75 per cent to 100 per cent of the current Union health budget. They also said the scheme caters to only 40 per cent of the population, which defeats the purpose of universal healthcare coverage.
The activists claimed that in the 2019-20 interim budget, the Union Ministry of Health received an allocation of Rs 61,398 crore. This is an increase of just Rs 7,000 crore over the previous year’s revised estimate. Out of the additional allocation, as much as 55 per cent (Rs 4,000 crore) has come in one scheme — PMJAY. In six months, the scheme was able to cover only 13 per cent (13 lakh) of expected hospitalisations, they claimed.
“In India’s existing healthcare system, there already exists a lot of health asymmetry as patients are hardly informed by doctors as to what treatment they are exactly getting and why they are getting it, and neither can a patient ask,” economist Jayati Ghosh said.
This scheme creates another layer of asymmetry because the patient, or the subscriber of the scheme does not know what exactly he is in for as all he has is a health card. What would have transpired between the hospital and doctor, the particular targeted population, which is at the lowest strata, would never exactly come to know, she added.
Ghosh also said the United States had experimented with this model years ago and it had failed badly. “Such is the trap that now, even if they want to come out of it, they are not able to. It was surely a wake-up call for all of us. It is not very late for India yet before we become as doomed as them,” she said.
There are many studies to suggest how insurance schemes like the Rashtriya Swasthya Bima Yojana not only failed to deliver but also led to many scams in the health sector. Why are we waiting for such scams to happen again to learn a lesson, asked Abhay Shukla, a physician and a public health activist.
Sulakshana Nandi, a Chhattisgarh-based health activist, said a pilot study in the state had revealed that poor people were actually cross-subsiding. They were paying for their premiums but due to lack of proper health infrastructure, they were not able to use them. Instead, people in towns could avail the scheme because of better hospitals and doctors.
The health activists demanded the abandonment of PMJAY and recommended absorbing it and other state insurance schemes into an expanded and strengthened public health system.
Does the government really spend a lot?
The JSA also reiterated a long-settled belief in Indian healthcare circles that the government needs to spend at least 2.5 per cent of the national GDP in the health sector (which comes to Rs 4,000 per person annually). “It is not too much. Central government employees, through Central Government Health Schemes, already get Rs 8,000 per capita and railways employees Rs 4,000 per capita,” social scientist Ravi Duggal, who has worked for more than four decades as a health activist, said. Out of this, the Centre’s share should be 40 per cent — which would require a tripling of the Union health budget. States would need to spend 60 per cent, which would require doubling of State health budgets.
On the other hand, the activists cited a forthcoming study, ‘A Quantum leap in the wrong direction’, saying the expenditure on the National Rural Health Mission (NRHM) has gone considerably down. While the annual growth on NRHM was 13.5 per cent from 2005-09 and 9.8 per cent from 2009-14, it grew negatively by 0.5 per cent from 2014-17, they said.
The activists also demanded that all private hospitals must be strictly brought under the Clinical Establishment (Registration and Regulation) Act to stop malpractices, and also strictly ban private practices by government doctors. “A patients’ rights demand charter has been uploaded for long on the health ministry’s website but never adopted. Why was it not?” Shukla asked.
Through their health manifesto, the JSA also demanded regulating the pharma industry by bringing all drugs under the Drug Price Control Order which fixes maximum ceiling price of the drugs. Duggal said, “While on the one hand, private drug manufactures are earning huge profits, on the other, pharma PSUs are in the doldrums today, almost on the verge of death. We are importing about 80 per cent bulk drugs from China."
The JSA also pitched for regularisation of Accredited Social Health Activists (ASHA) workers who serve on the periphery and the according of a fixed income of Rs 18,000 per month for them. “Health, unfortunately, never received a centre stage in elections. Hopefully now, with the buzz around several experiments over health schemes, it would become a major poll issue,” Ghosh said.