Context

In India, multiple policy pronouncements over the last few years have expressed an implicit intent to emulate certain features of the U.S. health system which is one of the most prodigal health systems, and it is a well-known reality that it is infamously poor-performing.

Emulating the U.S. health system in India and problems in this approach

• Implicit intent to emulate the U.S. system: In India, multiple policy pronouncements over the last few years have expressed an implicit intent to emulate certain features of the U.S. health system like-

1. Enhance private initiative.

2. And uphold the insurance route as the way to go for health care.

• AB-NHPS scheme: These are being largely envisaged while riding on the back of the Ayushman Bharat-National Health Protection Scheme (AB-NHPS).

1. AB-NHPS aims to provide insurance cover to nearly 50 crores poor Indians.

2. The mechanism to check insurance frauds: The AB-NHPS affirmed strong mechanisms to check insurance fraud which was commonplace in its precursor programme, the Rashtriya Swasthya Bima Yojana (RSBY).

3. New of fraud in AB-NHPS: Recently, 171 hospitals were reported to have been de-empanelled from the AB-NHPS on charges of fraud.

• How are the frauds in AB-NHPS sought to be tackled? The response to these has been envisaged through an unprecedented bolstering of administratively-heavy and technology-driven mechanisms.

1. Anti-fraud units: National- and state anti-fraud units have been established and partnerships with fraud control companies conceived.

2. One would ask this question: what is wrong in all of this?

• What is wrong with this approach? Let us return to the U.S. once again.

1. Administrative intensive: Multiple layers of complex arrangements and concomitant complex regulatory provisions have made the U.S. system one of the most administratively and technologically intensive systems in the world.

2. 50% spending going for the wages: More than 50% of health-care spending in the U.S. in 2010 went into health worker’s wages, with a large chunk of the growth in health-care labour taking place in the form of non-clinical workers.

3. Very little going into improving health: What this entails is that for every penny spent on health care, very little goes into actually improving health.

What are the concerns in emulating the U.S. system?

• Sub-satisfactory operations at the large cost: The new system necessitates-

1. A battery of new structures.

2. Personnel cadres.

3. Data systems.

4. And working arrangements only in order to sub-satisfactorily operate an insurance scheme that would cover less than half the population.

5. Disregarding the death spiral that policy-driven over-reliance on private health care could lead to considerable costs which would not primarily contribute to improving health outcomes.

   • Ethical concerns over unnecessary spending: While a besottedness with cutting-edge technology and state-of-the-art systems can help garner eyes and promote businesses, each unnecessary penny incurred this way raises significant ethical concerns.

• Problems of inadequate funding

1. Funding sufficient only for a quarter of beneficiary: Gupta and Roy have shown how the allocation for the AB-NHPS for 2019-20 would have covered less than a quarter of the targeted beneficiaries.

2. Paltry increase in allocations: For 2020-21, there has been a paltry increase in health-care sector allocation (5.7% above 2019-20 RE), while the allocation for the AB-NHPS is unchanged.

3. It is very possible that the AB-NHPS continues to remain insufficiently funded and incapable of extending considerable financial risk protection to the poor.

• Diversion of limited funds to wasteful areas

1. Attractive on face: Embracing the complexities associated with robust regulation of the insurance programme and making the requisite technological and administrative investments appear attractive and commendable on the face.

2. Diversion of limited fund: However, these complexities entail diverting highly limited resources towards wasteful and dispensable high-end areas.

3. These funds could have been set aside for much more pressing and productive domains, such as public hospitals and health centres.

4. Improvements in these areas would have strongly reflected in terms of tangibly better health outcomes.

5. AB-NHPS reinforcing contradictions: Rather, the AB-NHPS appears attuned to reinforcing a stark contradiction wherein trailblazing but unproductive high-end structures thrive alongside decrepit but potentially fructuos basic structures.

Conclusion

The fanfare with which AB-NHPS was launched, can hide the pressing concerns which lie underneath. The government must ensure that every penny spent on improving healthcare is used in the most optimal way and ensure that India’s AB-NHPS won’t end up the US healthcare way.