The COVID-19 Pandemic Has Exposed the State of India’s Public Health Infrastructure
As per data submitted to the Union Health and Finance Ministries, only 4% of the total number of patients admitted in hospitals to receive treatment for COVID-19 have health insurance. This shows a glaring under-presence of public healthcare and access to treatment for the needy and vulnerable sections of the population in the midst of a raging pandemic.
The National Health Authority (NHA) has declared that COVID-19 treatment is to be included under the Ayushman Bharat scheme (the Union Government’s flagship health insurance scheme for the poor). The Supreme Court even directed private testing labs to conduct COVID-19 tests free of cost for the poor. However, the question remains, how many of these measures are feasible and whether such feasibility is being assessed via actual implementation.
Ayushman Bharat covers approximately 50 crore beneficiaries, who are provided an annual primary and tertiary health coverage of up to ₹5L ($6,670) for the entire family. When COVID-19 treatment was included under its ambit, it wasn’t clear whether the inclusion pertains to both in-patient and out-patient needs since the scheme is predominantly used to cover only in-patient needs. This raises the question about whether provisions of PPE kits, OPD tests etc. fall under the scheme. Moreover, services of antibody tests and out-patient medicines for asymptomatic patients who aren’t hospitalised yet are a few other issues that beg the clarity of inclusion under the scheme.
When it comes to testing, the modes of reimbursement to private laboratories and clinics haven’t been instrumentalised yet, which in turn may discourage them to admit samples from the poorer sections. Without a robust and large public health care system to rely upon, increased private credence in COVID-19 treatment is a seeming reality. There is, however, the concern regarding justifiable payment to these hospitals from Government purses at a time when every expenditure of every single rupee from these purses is adding one to the gross national debt.
The Insurance Regulatory and Development Authority of India (IRDAI) has been issuing routine guidelines to secure claimants’ rights against insurers. Rules in the aspect of ‘associated medical costs’, which used to be the avenues for deduction under the claims have been tightened by excluding the costs of pharmacy, consumables, implants, devices, diagnostics, etc so that the insurer can’t refuse coverage towards these items. The National Human Rights Commission (NHRC) has also issued notices to the Ministry of Finance and IRDAI to explain the reasoning behind making the premium amounts for mediclaim policies so high for healthcare professionals who are the first responders in the fight against the pandemic.
India ranks 170 out of 188 countries in terms of expenditure as a part of GDP on health care, which is an abysmally low indicator in our preparedness to combat COVID-19. Although the economic stimulus package announced by the Finance Minister is intended to generate funds for public spending, it doesn’t include specific directives to strengthen the health sector vis-à-vis infrastructure, supply, modalities etc.
From an objective assessment, it is apparent that improving the state of health facilities in a country rests on scaling a lot of issues successfully. As far as the presence of medical and healthcare professionals (chemists, druggists, pharmacists etc.) go, India faces an acute lack of manpower. We have 1.34 doctors for every 1,000 people in the country. In addition to this, the severely understaffed and budget-compromised hospitals face an acute shortage of primary and tertiary healthcare workers, cleaners etc. who interact with the patients more directly than the doctors and are thus at a greater risk of exposure to the disease in their occupation.
As far as testing is concerned, instead of tasking state Governments with swift and fast-tracked establishment of clinical laboratories, the Government decided to issue authorisations en masse for existing private and public laboratories to conduct COVID-19 testing. These laboratories are not only stretched in fulfilling their testing capabilities but are also on the brink of severe financial volatility ever since the Supreme Court mandated the Union Government to cap testing prices.
The fact remains, however, that even if health infrastructure and medical appointments are sorted out, the access of basic healthcare to the poor is questionable. After facing a lot of increasing flak, the Government of Delhi decided to place a conditional cap on fees charged in private hospitals for treatment of COVID-19. A price cap of only 60% of the total number of beds in private hospitals are fixed at a daily rate of up to ₹18,000 ($241), which is again in excess of the median spending capacity.
The ability of a state’s citizens to afford basic healthcare is pivotal in the process of successfully essaying the fight against this pandemic. There is no substitute for affordable healthcare, seeing as it determines the rate of recovery from the illness at an individual level.
In spite of various schemes to identify and offer primary and tertiary care by the Government to the underprivileged in public health centers, dealing with a pandemic requires greater diligence. Employment of comprehensive strategies to conduct testing and treatment at subsidised rates in public or private hospitals is of utmost importance in these times. Although that would enormously increase public spending for a massively indebted economy, there is no other imminent strategy in sight that would liberate the world from the grip of the pandemic without reviving the health of all those ailing from it. Prudent maintenance of expenditure tabs, management records and timely reimbursement of private hospitals is necessary. In order to enable honest compliance from their end, a surveillance and deterrence mechanism must be also put in place that allows officials to monitor and assuage potential violations of the subsidised schemes through arbitrary pricing or fraudulent practices employed by private hospitals in defiance of the Government’s ruling.
The IRDAI must reform its role from being a nodal agency to one that courts and motivates insurance regulators to come up with affordable plans. For the time, Government stimulus should be offered to these companies to cover a part of their liability under various schemes so that the newer schemes are able to guarantee significantly lower rates of premium.
In the long haul, however, universal healthcare must be devised as an end to all the above temporary means to address healthcare of our citizens. If designed and administered properly by taking cue from the existing machinations in other countries, our citizens can ultimately see the day when basic health concerns would no longer factor into the developmental index of the country, because of the fundamental nature of existence.
(Originally published August 3rd 2020 in transfin.in)
