Dr KK Aggarwal
Universal health care (universal health
coverage, universal coverage, universal care, or socialized
health care) is a national health care system that provides health care and
financial protection to all citizens of a country. It provides a specified
package of benefits to all members of a society with an aim of providing
financial risk protection, improved access to health services, and improved
health outcomes. The health care does not cover everything for everyone.
The critical components are
·
Who is covered?
·
What medical services are covered?
·
How much of the cost is covered?
As part of Sustainable Development Goals (SDGs),
United Nations member states have agreed to work toward worldwide universal
health coverage by 2030.
In India with a population of 133.92 crores,
Ayushman Bharat will cover 50% of the population (40% or 50 crore people in
conventional scheme + additional 10 % people with income less than 8 lakh per
annum). For them insurance premium will be paid and shared by the central
government (60%) and state government (40%) from the central and state taxes
collected from the people.
Another 32% of the population is medically covered by
Employee State Insurance (ESI) (8% employees + 10% unrecognised sector);
Railway (9%); Defence (1.1%), state health insurance schemes (1%), Municipal
corporations (1%); CGHS (36,67,795 people) and PSUs (0.75 crore
family beneficiaries) [1%] another 1% is covered through private companies
(corporates).
The remaining 18% of the population comprises people with
annual income of more than 8 lakh per annum who can easily afford individual
private insurance.
To make universal coverage possible the options include:
·
The government should make it mandatory to have insurance
for those not covered by any government, PSU or NGO scheme.
·
Like ESI, it should be mandatory to have the employee
insured by the employer as part of his or her salary package.
·
Around 41% of the population has some life cover, which
should provide some medical cover.
·
Any individual with salary up to Rs 21,000 per month is
entitled for ESI insurance; this should also be
allowed for all those will salaries less than Rs 8 lakh per annum.
·
Ayushman Bharat provides coverage for up to 5 lakh for
the family. However, most packages are capped, and the average expenditure is
only Rs 18000/- per admission. Till today in the last 4 months, only 10
lakh people have been treated with an expenditure of only Rs 1800 crores (@ Rs
18000/- per person). At this rate, the annual expenditure will be only Rs 7200
crore (shared by center and state in a ratio of 60:40). This amounts to very
little for the country.
·
If required, the government can cover additional 18%
of the population also. With this the government will be able to ensure
coverage for 100% population and provide general ward basic and emergent
treatment to all admissions
For this to happen the government must also
ensure affordable health care by implementing one company - one drug
- one price policy; incentives to open Ayushman-only hospitals
by small healthcare doctor-owned setups and capping the prices of
National List of Essential Drugs, devices, reagents, investigations, equipment
and disposables.
The government should also make it mandatory for all
establishments to provide 10% beds for Ayushman patients.
The cost of providing universal national
immunization; “nationalizing” diseases and health issues of national importance
like TB, AMR, Leprosy, cancer, dialysis and providing free treatments to all
should continue via the national health annual budget, which itself should be
raised by another 25% to be made around Rs 75000 crores. This budget should
cover the proposed 1.5 lakh wellness centers.
To further improve the health budget, the total budget
for environmental pollution (air, water, earth); budget for women and child
health, mid-day school meal, Swachh Bharat, road safety, pharma sector, food
industry etc. should be merged with an aim to reduce the disease burden.
The government should provide coverage only for general
ward treatment. There will still be enough business left for private and
national insurance companies for additional insurance coverage for private
wards and diseases not covered under Ayushman Bharat.
Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical
Associations in Asia and Oceania
(CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA
