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 Under the National Health Assurance Mission, Prime Minister Narendra
Modi's government would provide all citizens with free drugs and
diagnostic treatment, as well as insurance cover to treat serious
ailments.
The proposed plan would be rolled out in phases from April 2015 and
will cover the entire population by March 2019, C.K. Mishra, an
additional secretary at the health ministry, told Reuters. When the
entire population is covered, it would cost an estimated $11.4
billion annually.
"If you want to deliver the service, that is what it will take,"
Mishra said, disclosing for the first time an expert group's cost
estimates that will be considered by the finance ministry for
inclusion in the government's spending plans.
Healthcare experts caution that it could take decades before India's
1.2 billion people are adequately covered and that the costs of
provision could face significant upward pressure.
If approved, India would need to drastically raise its healthcare
spending. In the current financial year, the federal budget
allocated about $5 billion to healthcare.
"We are not in a position to implement it across the regions, states
(right now). It's impossible. So we are choosing number of districts
each year," said Mishra.
Despite rapid economic growth in the last 20 years, the Indian
government spends only about 1 percent of gross domestic product on
healthcare. That compares to 3 percent in China and 8.3 percent in
the United States.
More newborns die in India than in poorer neighbors such as
Bangladesh, and preventable illnesses such as diarrhea kill more
than a million children every year.
Government hospitals are overcrowded and lack resources to meet the
growing demand, while access to basic health services in rural areas
and smaller towns remains poor.
"I can say that you are covered, but your closest facilities are 100
kilometers away. You are limited by that fact," said Rana Mehta,
leader of healthcare at consultants PwC India.
"To build infrastructure and then provide care over a period of time
would obviously take decades."
A 2012 study by Indian business lobby FICCI and consultants EY
estimated that universal health cover in India was feasible in a
decade and would require government health spending to rise to
3.7-4.5 percent of GDP.
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PLAN STRUCTURE
The new plan will focus on improving preventive healthcare services
by ensuring adequate availability of medical practitioners in rural
areas, while new infrastructure will be created under existing
welfare programs, Mishra said.
Tertiary care services would be provided through an insurance-based
model and the government will offer more than 50 drugs free to all
its citizens.
Along with the drugs, about 12-15 diagnostic treatments will be
offered in the package.
Mishra said states will be encouraged to enter into outsourcing
agreements for the provision of treatment.
In recent years, thousands of small private hospitals and test
centers have flourished, betting on high demand created by lack of
adequate public facilities. Such providers opened 80 percent of
India's new hospital beds during 2002-2012, according to a
PwC-NatHealth report.
While private players will be involved in the ambitious program, the
government will need to ensure speedy payments for the partnership
to work, said Harish Pillai, chief operating officer at private
healthcare group Indus Health.
"Private providers can definitely help and execute it better, but
the government should not only see us as commercially-driven
entities," said Pillai.
The World Bank and Britain's health cost-effectiveness agency NICE
are also assisting India, providing technical assistance and advice
on treatments the government should offer in the package, the bank
said last week.
(1 US dollar = 61.4200 Indian rupee)
(Reporting by Aditya Kalra; Editing by Douglas Busvine and Simon
Cameron-Moore)
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