Experts believe with implementation of the plan, India's health care would largely depend on the private sector
A report released by the
Confederation of Indian Industries (CII) on Monday recommended that a
model which allows public sector to deliver services like antenatal care
and immunization and private insurance to cater to emergency and
curative services will be effective in implementation of universal
health coverage.
The report, released at the Seventh Health Insurance Summit, said
that in this model every family in India will be registered in single
insurance scheme for all three levels of medical care—primary, secondary
and tertiary. The services will be divided between the government and
private players.
Public health experts have, however, criticized the model as they
believe that with its implementation India's health care would depend
largely on the private sector.
The draft 12th year plan,
had proposed the same model and had drawn a lot of flak from public
health experts. Despite this, the final 12th Plan report maintained the
same provision. The CII report is a step forward in that direction as it
pushes for implementation of the provision.
‘Need to standardize treatments’
According to the proposed scheme, a family shall be the unit of cover
and those who are not covered within the definition of a family can be
included in the scheme by paying an extra premium. The report says that
in due course of time, this will help establish a proper referral system
and the doctors will be able to diagnose a disease and identify the
type of care a patient needs. This will take away pressure from
tertiary healthcare units, which at present cater to primary needs as
well.
Preventive Services: Antenatal care, Immunisation, Screening for specific diseases, ambulance service
Promotive Services: safe drinking water, Nutrition services, IEC services, Tobacco control, Sanitation, Councelling, Anti-vector measures
Curative Services: Outpatient care, Emergency services, Inpaient services, Delivery services, CEmOC services, ICU services, Follow-up care |
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“We need to establish proper referrals. A person needing primary
healthcare service should be able to recover in a primary healthcare set
up. The doctor whom a patient approaches first should be able to send
the patient to the required facility after a proper diagnosis. Only
patients who need high level of care should be referred to a tertiary
care facility,” said Nishant Jain, deputy programme director at
international non-profit Indo-German Social Security Programme GIZ and a
contributor to the report. He added that detailed guidelines for
treatment of every disease should be prepared so that extra medical
tests or treatments which cost more can be avoided, thereby reducing the
burden on insurance companies.
M Ramaprasad, member (non-life) Insurance Regulatory and Development
Authority (IRDA) said, “The difference in costs involved in cashless
scheme and reimbursement in insurance show a difference of nearly 20 per
cent. It is known that cashless hospitalisation costs less as compared
to an insurance where amount has to be reimbursed. This happens because
hospitals charge from patient extra amount in case of reimbursement,
much to the worry of the insurers.
The report emphasizes that agricultural labourers and the non-poor are yet to avail of proper health insurance in the country.
