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F
ew politicians can beat the ambition
and audacity of schemes conceived
by Prime Minister Narendra Modi.
The latest one is the announcement by
Union finance minister Arun Jaitley in
this year’s budget of the National Health
Protection Scheme, or Ayushman Bharat.
This tax-financed health insurance
scheme for the poor will give 100 million
poor families, or around 500 million
people, a Rs 5,00,000 cover per fam-
ily per annum. It is the world’s largest
healthcare scheme. Modicare, as it’s now
being called, will provide state-funded
healthcare to a population bigger than
that of South America. Prime Minister
Modi, known for his big ideas, called
the scheme ‘a path-breaking initiative to
provide quality and affordable healthcare’
and said it would usher in a ‘paradigm
shift in our health sector’.
This is very laudable. Rarely have
health and education become issues for
political debate, which could, in a way, ex-
plain the rotten state of health and educa-
tion over the last few decades. Politicians
have been happy to seek votes on divisive,
emotive issues like caste and religion. Yet,
as is the case with all other large state-
sponsored schemes, there are serious
issues with the proposed implementation
of this gigantic scheme.
The pathetic state of healthcare is one
of India’s biggest policy blights. Seventy
years after independence, 86 per cent of
rural Indian patients and 82 per cent of
urban patients do not have access to
any form of employer-provided or state-
funded insurance.
The link between health and wealth is
a fact that should be more widely acknowl-
edged. One-sixth of India’s poverty burden
results from out-of-pocket health expendi-
ture, which also deters the poor from
seeking treatment. Sixty-three million
Indians (that's more than the population
of Karnataka) are pushed into debt due
to healthcare spending each year. Indians
are tormented by a twin-pronged disease
threat—traditional ailments like diarr-
hoea and tuberculosis—and lifestyle or
non-communicable diseases like obesity,
diabetes and heart ailments. A broken
healthcare system makes treatment so
much more complicated. There is just
one state-run hospital for every 90,343
persons and 0.9 beds for every 1,000 rural
persons. The void created by subsidised
but dysfunctional state government hos-
www.indiatoday.in
EDITOR-IN-CHIEF
HOW THE BJP SWEPT UP
www.indiatoday.in
9
7 7 0 2 5 4
THE CAPTAIN’S
CHALLENGES IN PUNJAB
MARCH 27, 2017 `60
8 3 9 9 0 9
AFTER A
STUNNING
ELECTION
VICTORY, MODI
SETS HIS
SIGHTS ON
A ‘NEW INDIA’
FROM THE
Modi COVER.indd 1
15/03/17 4:02 pm
The March 27, 2017 cover
pitals is being filled by efficient but often
expensive private sector hospitals. Afford-
able healthcare, it would seem, is beyond
the reach of most Indians.
Past attempts to implement large
healthcare schemes have been dismal.
The Rashtriya Swasthya Bima Yojana
(RSBY), launched by the central govern-
ment in 2008 with mirror schemes in the
states, offered an insurance coverage of Rs
30,000 for below poverty line families. A
2017 study by the academic journal Social
Science and Medicine found that RSBY
was ineffective in reducing out-of-pocket
expenditure among the poor.
Will Modicare meet the same fate?
This is what our cover story, put together by
Executive Editor Damayanti Datta, looks
at. The scheme does mark a commendable
first step towards universal health cover-
age. But there are issues. There is no clarity
on cost. Estimates vary from Rs 10,000
crore to Rs 1 lakh crore while the provision
in the Union budget is only Rs 2,000 crore
for RSBY plus 1 per cent health cess. Where
will the money to finance this scheme come
from? How will the deserving candidates
be identified? How will they pay for their
insurance? Where are the resources, the
workforce or the hospitals? What is the
timeline for its execution?
A healthy population is a wealthy
population. This is a fundamental lesson
for a country set to be the world’s third
largest economy by 2030. Implement-
ing Modicare is clearly going to be the
biggest challenge and a personal one for
the prime minister since it is now fused
with his name in public memory. This is a
chance to either leave his mark on history
or be remembered for not having cared.
I can only wish him luck in this noble
endeavour. He will need it.
(Aroon Purie)
F E BRUA RY 19, 2 018
INDIA TODAY
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