Ideas

Health Insurance Is Of Little Avail When Health Infrastructure Is Tottering

S Murlidharan

May 23, 2021, 01:30 PM | Updated 01:30 PM IST

Health insurance.
Health insurance.
  • The moot question is if healthcare is all about health insurance.
  • The answer is a definite 'no' as the recent events have proved — people in Delhi, Bangalore and Mumbai afflicted with the coronavirus gasping for oxygen or even proper hospital beds.
  • Ayushman Bharat — launched in 2018 with a lot of fanfare by the Narendra Modi government targeting a large chunk of the population numbering 50 crore — is essentially the financing solution to the problem of illness most families shudder to face.

    Many poor families in the past had to sell their family assets like gold and land to meet the tertiary care expenses in the unfortunate event of a life threatening disease striking a family member.

    They had found immense relief from the scheme before Covid-19 rocked the entire world including India.

    Indeed, the Corona pandemic has found almost all the healthcare systems led by the US’ insurance model and the UK’s NHS model wanting barring a few honourable exceptions like Taiwan, which set store by the sobering adage — "Prevention is better than cure".

    But the moot question is if healthcare is all about health insurance. The answer is a definite 'no' as the recent events have proved — people in Delhi, Bangalore and Mumbai afflicted with the coronavirus gasping for oxygen or even proper hospital beds.

    It is not only the physical infrastructure that is being tested to its limits, but also the availability of health personnel driving the government to requisition the services of the final year MBBS students.

    Founder of Narayana Hridayalaya Devi Shetty's wistful lament that India could do with ten times more doctors and nurses than it presently has is a poignant commentary on the state of human health infrastructure in the country.

    Health insurance pits the insurer against the hospital and the hospital against the patient.

    Hospitals salivate at the prospect of treating patients with ample insurance covers. Milking them is irresistible, which, perhaps, explains why Rs 11,794 crore only has been settled so far in India towards corona insurance as against the claim of Rs 22,955 crore.

    The claims of over 2.5 lakh customers involving Rs 11,161 crore are yet to be cleared apparently because of the legendary adversarial relationship that exists between hospitals and insurers.

    Insurers suspect huge padding by hospitals.

    The US, though a pioneer in health insurance, has also tried managed healthcare by hospitals under which the hospitals step into the shoes of insurers by dispensing with their services.

    It has the advantage of doing away with meddlesome middlemen. Hospitals offer free health services on payment of annual premia just like in health insurance, except that patients have to make do with the hospital or its chain and cannot scout for the best hospital in town as it happens under the insurance model.

    The main advantage of managed healthcare is hospitals getting funds in advance and being able to ramp up infrastructure. They are also likely to be mindful of the quality of their services as well as needless defensive investigations, at the pain of losing both existing and new customers.

    Scrimping on needless investigations also benefits the hospital providing managed healthcare.

    The UK model of National Health Service (NHS), under which all residents are entitled to free healthcare theoretically, is appealing, especially in the light of UK spending 9.2 per cent of its GDP on it.

    Yet, it was rattled by the Coronavirus at par with the US, thus hammering home the message that at the end of the day, what matters is the sound health infrastructure a country has put in place.

    India needs to catch up with the advanced countries on doctor-population ratio by weaning away bright students from the allurements of engineering and management education.

    The Indian public resents fancy fees of specialist-doctors and hospitals while winking at the fabulous salary packages of finance whiz kids in mutual funds and banks — most of them ironically from engineering backgrounds.

    Health is a state subject in India. It is, perhaps, time to amend the constitution to allow the central government a greater say in health matters including setting up of an institution akin to NHS of the UK in the sobering realization that accessibility of quality health services is more important.

    Insurance aggregators in India like Policybazaar, as it is, rank health insurers on the touchstone of premium mainly, blissfully ignoring the hospitals they would get access to.

    In a milieu of managed healthcare, they would have to factor in hospitals too because, come to think of it, healthcare is more about hospitals and less about insurers.


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