The National Health Policy 2017: Through the Accountability Lens (Part 2)

II. National Health Insurance Scheme (NHIS)

One finds it perplexing that there is no discussion on national health insurance scheme (NHIS) of the Government of India in the NHP 2017.  The 28-page NHP 2017 document makes one passing reference to NHIS in context of covering selected benefits through strategic purchasing by the government.

Various state governments during the last decade have responded to OOP expenditure on health challenge by implementing demand side financing options. For example, the implementation of targeted health insurance options such as RSBY and RSBY+ by pooling the risks and providing protection from catastrophic expenditures started by the Ministry of Labour and later shifted to Ministry of Health and Family Welfare has been one major health financing reform.

As per the IRDA annual report of 2015-16, about 273 million persons are covered through various government-sponsored health insurance schemes currently in India. The annual spending by government, having contributions from both centre and state, on these schemes is about Rs 2,500 crore per annum of which the central assistance is to the tune of Rs 1500 crore. 

The announcement of new health protection scheme by the Finance Minster during 2016-17 budget speech also proposed an incremental health reform for RSBY by promising to increase the health cover to Rs 1 lakh from Rs 30,000 per family per annum. An additional top-up package of Rs 30,000 for senior citizens was also approved and implemented with effect from 1 April 2016.

The implementation of NHIS has been projected an important foundation for the national framework for the universal health care (UHC).

The situational analysis report presented as part of NHP 2017 identifies a number of challenges with NHIS. However, The NHP 2017 does not give any indication how the government would like to take this important demand side intervention forward and how are they going to address various challenges in implementing this insurance scheme.

One was expecting some discussion and deliberation on the NHIS. For example as can be seen from figures presented below, that in 12 states the targets of family coverage are below 60 percent and in significantly a large number of states the utilization of the scheme remains at very low levels (source RSBY Programme website http://www.rsby.gov.in/Statewise.aspx?state=16 accessed on 20 March 2017).

We have lost an opportunity to discuss an important issue on the role of insurance in national health protection and inclusiveness of population coverage (targeted to universal).

Among other things issues such as inclusiveness and comprehensiveness of benefits and coverage including integration with primary care were critical at this juncture of making health protection strategy effective. 

The policy could have laid the foundation for articulating strategies to strengthen the NHIS focusing on the 

• administration and institutional framework to ensure standards for service providers, 
• incentives for efficiency in the use of medical resources, 
• reimbursement of providers, and 
• delivery and resources. 

All these have a significant bearing on the impact on the efficiency of resource use. The policy has missed an opportunity to reflect on the national health protection programmes and pathways of balance the system of reforms on (a) population coverage (who benefits and basis of subsidizing their needs), (b) programme benefits (and incentives for efficiency in the use of medical resources) and (c) financing (equity issues in financing) with implementation feasibility. 

None of these find a reference in NHP 2017.