While presenting the Union Budget for 2018-19, Finance Minister Jaitley announced two major initiatives in the health sector, as part of its much-publicised Ayushman Bharat program. These are the Health and Wellness Centre and National Health Protection Scheme.
The Health and Wellness Centres are being promoted as the ‘foundation of India’s health system’. The government has announced that 1.5 lakh such centers will be set up, to ‘bring health care closer to the people’. The government claims that these centers will provide comprehensive health care, including for non-communicable diseases and maternal and child health services. It is also claimed that they will provide free essential drugs and diagnostic services. The scheme is to be implemented through the state governments. The Budget has allocated Rs.1200 crore for this program. This comes to an investment of Rs 80,000 per Health and Wellness Center – totally inadequate to provide the required health care.
The National Health Protection Scheme (NHPS) is a new health insurance program The scheme will not cover out-patient services. Promising to cover 10,00,00,000 poor families in the country, the Finance Minister claimed that it would be the “world’s largest health care program”.
The Government claims that it is acting in the interest of the poorest 40% of the population. However, there are many facts which indicate that there are other interests, powerful private interests, which are behind this new scheme.
The entire scheme has been and continues to be designed by Niti Aayog in close collaboration with the Bill and Melinda Gates Foundation, owned by one of the richest American capitalists. Why would an American capitalist billionaire be interested in supporting a publicly financed health insurance program targeted at poor people in our country?
The expansion of health insurance coverage can generate a massive increase in profitable business for private hospitals and private insurance companies. That is the reason why American capitalist billionaires are interested in promoting a publicly subsidised health insurance program that would increase the number of patients in private hospitals.
Health Care – a universal human right
The Ayushman Bharat Scheme has been announced at a time when, every day, brings shocking news of death of children in overcrowded government hospitals lacking even basic facilities, and private hospitals fleecing patients. The vast majority of people have practically no access to health care. India’s infant mortality rate and maternal mortality rate are among the highest in the world. Millions of children die every year from diseases which are completely preventable.
In rural areas, people have to often travel tens or hundreds of kilometres to access the nearest hospital for even basic medical services. Primary health centers are either non-existent or severely lacking in infrastructure and medical supplies and services, doctors, nurses, etc. In urban areas, the long queues of sick people waiting for treatment outside the government hospitals, the terrible crowded conditions and lack of basic services, such as oxygen cylinders in the government hospitals, are indicative of the utterly inadequate health service provided by the state.
Consequently, the people of our country suffer from ill health more than most other countries in the world. The “burden of disease” in India has been estimated to be more than twice the level in China and in west Asia. However, the level of public spending on health is abysmally low. The combined expenditure of the central and state governments on medical services, public health, drinking water and sanitation, has remained at around 1.25% of the Gross Domestic Product, ever since 1991.
The Indian state has taken no serious steps to deal with the terrible conditions of public health care. India is ranked among the worst countries, in terms of universal public health care, in the world. The working class, women and many other sections of our people have been demanding that health care be recognised as a universal human right, which the State is duty bound to guarantee, either free of cost or at low affordable prices.
The proposed National Health Protection Scheme is targeted at those families which have been certified as being below the poverty line. Families with a BPL card issued by a state government are eligible to enrol, and those who enrol can go to a private hospital for treatment of a specified list of chronic diseases. The expenses will be covered by insurance, for which the government is committing to pay the premium. The insurance premium for this scheme will be paid by further looting all the working people, through increasing the burden of direct and indirect taxes and other forms of extortion by the state.
Millions of poor families who cannot get a BPL card will get left out. Even for those who enrol, the new scheme will cover only the cost of hospitalisation for certain diseases. It will not contribute even one rupee to the cost of out-patient care, such as when one consults a doctor and purchases the medicines prescribed.
What is the reason for the Government to cover the cost of hospitalization and not out-patient care? The reason lies in the private interests of big capitalists who are keen to expand the profits of private hospitals, not only in the metros but in many more cities and towns.
Privatisation in the name of PPP
The proposed new health insurance scheme needs to be seen in connection with other initiatives that have already been taken under the banner of public-private partnership or PPP in the health sector. One such initiative is a World Bank project under which large parts of the space and infrastructure of District Hospitals are being rented out to private companies.
The system of public hospitals, community health centres, primary health centres and sub-centres in every district of the country was created by investing public funds. The stated aim was to ensure that basic health care services are available free for all members of society. This public health care system is in a terrible condition today because it has been neglected and starved of funds by successive governments of the capitalist class.
In spite of shortage of staff and supplies, the public system remains the only accessible and affordable source of health care for millions of people in the country. This can be seen from the huge crowds and long queues at all public hospitals, from district hospitals to the All-India Institute of Medical Sciences. The common interest of the workers, peasants and vast majority of the people lies in strengthening and fully funding the public health care system. Not only the hospitals but the entire network down to the sub-centres at the village level needs to be strengthened.
The public interest will be best served if the public health system is fixed and made to deliver good quality services. This requires a huge increase in the combined government budget along with increasing attention to
service quality.
The Government of India is moving in the opposite direction. It is guided by the mantra that public health provision has failed and the solution lies in expanding the space for private health provision. The real aim of the NHPS is to guarantee a sizable and growing market for private companies which have entered the premises of public hospitals.
Under the banner of “public-private partnership”, public assets are being turned into private capital. Public health infrastructure, instead of being used to deliver high quality services to the public, free of charge or at affordable nominal rates, is being turned over to profit maximising companies.
The biggest capitalist companies that control numerous private hospitals in the country were reportedly consulted by Niti Aayog in formulating the proposed National Health Protection Scheme.
Conclusion
The Ayushman Bharat, is not a step towards guaranteeing free or affordable health care as a basic right of all members of society. The intention is not to fulfil the demand for universal health care. On the contrary, the intention is to extend public financial support towards expanding private hospital based treatment of some selected diseases. It is one more step in the direction of wrecking the public health care system for the sake of guaranteeing maximum private profits for capitalist billionaires.
In brief, the so-called Ayushman Bharat scheme does not contribute to national health nor protects all people from ill-health. It is an anti-people and pro-capitalist scheme.