The announcement in the Union Budget of an >insurance scheme against catastrophic health expenditure for the weaker sections should become part of a >calibrated plan to provide universal health coverage . When it comes to public health expenditure, India brings up the rear among even many developing countries. >Budget 2016-17 takes the incremental step of introducing some insurance protection against high out-of-pocket expenditure that pushes families into poverty. In this context, the plan to provide access to dialysis for kidney failure at district hospitals through a dedicated national programme is an intervention that is overdue. Some States, such as Tamil Nadu, have insurance to pay for hospitalisation through a government-backed plan. As a scaled-up national programme, there is much to learn from the experience of countries such as Thailand and Japan. What stands out about them, as evident from a study conducted by the World Bank and the Japanese government, is the use of general revenues to augment payroll taxes in Thailand, and the firm capping of care costs through standardised benefits and standardised payments. Both aspects — viable funding to universalise access and tightly regulated costs to guard against profiteering — combined with a guarantee of quality care are important to India, where the health sector has grown amorphously in the absence of strong regulatory oversight. These learnings are critical to also avoid the moral hazard of unethical institutions gaining access to the Rs.1 lakh government-funded health insurance through unnecessary hospitalisation.
A nominal increase in the annual health budget, pegged at 9.5 per cent over 2015-16, and a growing role for profit- oriented care systems and private insurance can only retard India’s progress towards universal health coverage (UHC). There is evidence that a significant number of young Indians aged 23 to 35 are not buying health insurance since they find it expensive. This trend skews the risk pool towards older citizens who are more likely to seek care, leading to the familiar cycle of higher premiums and more claims. The answer clearly lies in moving towards UHC under a time-bound programme that covers everyone, using a combination of subscriber payments and tax funds, and strong controls over cost of care. There is a challenge also to >scale up dialysis access . Besides equipping district hospitals with the necessary machines, training of medical professionals to closely monitor patients availing the service is vital. The national roster of nephrologists is only about 1,100 strong, while the incidence of renal failure is of the order of 2.2 lakh patients a year, as pointed out in the Budget speech. Creating the human resources needed has to be accorded top priority. The dialysis programme, laudable as it is, underscores the importance of preventing end-stage renal disease, and regular monitoring of kidney health at the population level. On the broader agenda, political parties and social movements can no longer ignore the imperative of providing quality health care to all.
