If the Assam government’s initiative to launch a health insurance scheme ‘Atal Amrit Abhiyan’ from April 1 next year materializes on schedule and is administered well, it promises to provide much succor to a large section of the people. After all, this is a country with almost non-existent medical insurance for citizens; whatever little insurance facilities available are for the moneyed. When nearly three-fourth of the country’s population lack even basic food security, how can they afford the prohibitive costs of treatment and health care? Most people admitted to hospital with a mundane health complaint or needing a routine operation — know how overwhelming the costs can be. Health being wealth takes topmost priority, and families can be reduced to utter penury in meeting mountainous hospital bills. It keeps happening with dismaying regularity in Assam; in particular, rural families selling off land and taking loans they can never return. The issue is serious enough across the country to have merited a reference in Prime Minister rendra Modi’s I-Day speech this year, in which he spoke about health care services getting costlier by the day. For families below poverty line, he announced a scheme that the Government of India will incur an expenditure of up to Rs 1 lakh for treatment. In fact, the PM is believed to have played safe by keeping this proposed scheme confined to BPL families, in line with his earlier I-Day announcements of Jan Dhan bank accounts for the poor and low-end pension as well as life and accident insurance policies. Once the Central government works out how effectively these schemes have been implemented and how well the finces hold up, it may follow up with a universal health insurance scheme to cover cashless hospitalization for diseases contracted or injuries sustained. State-run as well as private insurers are reportedly working with the government to thresh out the dimensions of such a scheme. It will doubtless be a huge leap, because if the government is not willing to subsidize it overmuch, it will be the insurers who will have to sell the policy at highly subsidized rates. So will the public response be enthusiastic enough to guarantee a volume sufficiently big to help insurers provide wider covers at comparatively lower premiums? If a universal health insurance scheme comes about in near future, it will provide the lower and middle classes at least a rudimentary cover to meet healthcare contingencies.
The country does have a Rashtriya Swasthya Bima Yoja (RSBY) running for seven years now. But so far, this Central government operated health insurance scheme has covered only 12 percent people in cities and towns and 13 percent people in villages. A tiol Sample Survey (NSS) report in April this year showed that around 86 percent of the rural population and 82 percent of the urban population were not covered under any scheme of health expenditure support. The study also reflected how the state is gradually retreating from healthcare. Private doctors were found to be the single-most significant source of treatment in both rural and urban areas; 72 percent of the treatment in rural areas and 79 percent in urban areas was provided by the private health sector. Not surprisingly, the biggest obstacle in seeking medical treatment was cited to be ‘fincial constraint’ by nearly 60 percent respondents in the survey. Considering how vital this issue is, the Assam government will earn a lot of credit if it makes a success of its smart card-based ‘Atal Amrit Abhiyan’. To provide beneficiaries with Rs 2 lakh insurance cover at Rs 100 premium, the State government will have to shoulder a yearly burden of Rs 200 crore. It all depends how well government and CGHS hospitals deal with such beneficiaries. There is another aspect that needs be watched. Agents of some health insurers are known to strike up an unholy ‘understanding’ with hospital authorities, resulting in the patient getting over-billed. The patient mostly remains uware, or chooses to remain silent so long as he does not have to fork out cash in hospital. But the bottom line is that his health cover gets fraudulently reduced — to his detriment if he or any other family member needs hospital treatment in future. Such malpractices have to be checked if the State government is to get its health insurance initiative up and running smoothly.