NHPS: The way forward

The Union Budget announcement of the launch of the National Health Protection Scheme (NHPS) by the Finance Minister Arun Jaitley this year has left healthcare experts, economists, analysts, healthcare critics and media contemplating on the prospects of the scheme and its economic impact on the nation. While most of the industry players both in the private sector and government seem to be upbeat of this initiative as they see huge opportunities for improving the healthcare system, there are few who are skeptical of its implementation and influence on the system in the long run.

Healthcare Sabha’s panel discussion on ‘The way forward for NHPS’ deliberated on how this scheme can be beneficial from the healthcare provider and patient point of view.

The panelists for this discussion were, Moderator: Dr Prateek Rathi, Special officer, ESCI, Govt of Maharashtra, Bejon Misra, International Consumer Policy Expert and The Partnership for Safe Medicines (PSM) India, Dr Raju Sukumaran, State Medical officer, MoH&FW, Government of Kerala and KB Vijay Shrinivas, GM, National Insurance Company.

Dr Rathi began the discussion by giving a brief about the ambitious plan under the NHPS and the doubts surrounding the implementation. He highlighted the key factors, such as costs involved, the burden of medical impoverishment, role of states in the execution of the scheme, issues of supply, moral hazard, etc.,  that are essential for the successful implementation and sustainability of NHPS.

Misra explained his view on NHPS and how it will be a game changer for the sector. He also said whether the government’s move from a provider to a purchasers will work for India or not. He said, “The NHPS will serve as an institutional scheme in our healthcare system, where there will be no differentiation between public and private. We have been listening to people saying that healthcare services is for free several times, but nothing is for free. Healthcare costs are either paid by the tax payers’ money or by people themselves. I feel that the NHPS will bring a sea change in the insurance sector of our country. IRDA cant sleep any longer. They will have to ensure transparency in insurance dealings.” He then asked the audience whether they knew about the functioning of reassurance companies. He then informed the audience on how the reassurance companies function and said, “The NHPS will  empower the patients to decide where they would like to avail their healthcare services.  This will allow the patient to choose whether they want to go to a private healthcare provider or a public healthcare provider and the government will pay for the same.”

He firmly said that NHPS will be a catalyst for pitting the public and private sector against each other in order to provide better healthcare services to the people. This will, in turn, only better our healthcare system as competition drive better quality and brings in affordability.

Key Takeaways:

• NHPS will empower the patients
• Technology will play a key role in the effective implementation of this scheme
• The issue of moral hazard and how this leads to manipulation of healthcare cost needs to be addressed
• Transparency, talent utilisation should also be looked at while structuring NHPS

Misra’s point on the availability of choice for patients was well taken by the audience and the panelists. However, Dr Rathi pointed out that India  has a very poor legal system and regulations for healthcare. In such a scenario, how much availability of  choice will be possible and how can we ensure that this will not lead to exploitation of patients, he questioned, Misra. On this, Misra replied saying, “Here technology will play a very big role. Data will be collected in realtime. All records will be cloud-based. Corruption will be curbed. We have to ensure that at least in healthcare, there cannot be any fraud or manipulation.”

Dr Rathi then, asked  Shrinivas to speak on the cost factor of NHPS. Shrinivas drew parallels between the cost analysis of RSBY scheme, NHPS and the Pradhan Mantri Fasal Bima Yojana (PMFBY). “There has been a wide range of difference in cost and it is completely related the market dynamics at the moment,” he informed.

Dr Rathi further brought up the issue of moral hazard and how this leads to manipulation of healthcare cost in the public sector and budget utilisation. Shrinivas explained the analysis of how the cost curve is derived in any given public health scheme. He further pointed out that in the initial year of a health programme the cost incurred in a scheme is less, but as time passes by and people are more aware of the programme there is more utility and more addition to cost. Expounding further on the cost curve he said, “The reason why the graph only keep shooting high is because of the spiralling costs. What was available for Rs 5-10, years back, is now available for Rs 50 or Rs 100. Be it cost of medicines,hospitalisation, doctor’s fees etc., and the moment a patient says that he/ she is insured, there is malicious glow on the face of some healthcare providers. attitude of healthcare providers towards patients having health insurance. These are some aspects as to how all the cost keeps mounting each year. Well, moral hazards will continue to happen but technology as mentioned earlier will play a key role in bringing this down.”

Dr Sukumaran shared his perspective on the role of states in the execution of the scheme. He also spoke about the challenges states face in their current schemes and the doubts they have regarding NHPS. The discussion was then open to the audience for questions. The audience raised questions related to transparency, talent utilisation and more.

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