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Monday, 28 May 2018

The Hindu Editorial: A Health Scheme That Should Not Fail

Mahendra Guru
The Hindu Editorial: A Health Scheme That Should Not Fail

Title: A health scheme that should not fail 

(The implementation of Ayushman Bharat requires a strong reform agenda) 

Context:- The launch of Ayushman Bharat, a national health protection scheme (NHPS), in the last stretch of this government’s tenure comes as no surprise. Social policies in the areas of education, health and the welfare of the disadvantaged or farmers almost always get announced before elections. 

No political party is an exception to this rule since such ‘feel good’ welfare policies are useful in conferring a sense of legitimacy and caring on the government seeking another term. 

Despite these political motivations, those working in these neglected sectors welcome such policy announcements as the crisis is acute in these sectors. 

Health policies have two objectives: to enhance the health of the population and reduce the financial risk for those accessing treatment. 

The scheme has two components: upgrading the 150,000 sub-centres (for a 5,000 population level) into wellness clinics that provide 12 sets of services; and providing health security to 40% of India’s population requiring hospitalisation for up to a sum assured of ₹5 lakh per year per family. 

These initiatives can help achieve the goals of equity, efficiency and quality. 

Key issues 
An evidence-based strategy will need to address and resolve several key issues affecting the sector. The first is the massive shortages in the supply of services (human resources, hospitals and diagnostic centres in the private/public sector).

For example, even a well-placed State such as Tamil Nadu has an over 30% shortage of medical and non-medical professionals in government facilities. 

A related question that arises is that while the NHPS will empower patients with a ₹5 lakh voucher, where do they encash this? The health budget has neither increased nor is there any policy to strengthen the public/private sector in deficit areas. 

The Government of Andhra Pradesh launched the Rajiv Aarogyasri Healthcare Insurance Scheme in 2007 for the 2.03 crore below the poverty line (BPL) families in Andhra Pradesh. 

Under the scheme, BPL families can avail health benefits through affordable insurance. The premium for this policy is financed by the government. A sum of 150,000 rupees is reserved for each BPL family with a buffer amount of 50,000 for unexpected expenditure. 

The price factor: 
Second, the strategy for negotiating/containing prices being charged for services needs to be spelt out. 

A three-day stay in a hospital for a respiratory problem cost me ₹1.8 lakh. In order to understand the extent of overbilling, I checked ‘Rajiv Aarogyasri’, the health insurance programme in Andhra Pradesh. 

The rates here were not only incomparable but also did not reflect market prices of common procedures or treatment protocols to be followed by hospitals. So a CT scan that costs ₹19,080 in the Hyderabad hospital (it is the same rate across the city) was only ₹500 in government hospitals in Tamil Nadu (₹7,000 in private hospitals in Tamil Nadu and Delhi). 

There is no way the government or the payer has an idea of the shifts in the price of components within the package. This knowledge is essential to regulate/negotiate prices to contain costs. This also explains why there is no dent in the exorbitant health expenditures being faced in India despite government-sponsored schemes. 

Finally, the absence of primary care. The wellness clinic component is a step towards bridging that lacuna, but with no funding, the commitment is hollow. 

In the northern States there are hardly any sub-centres and primary health centres are practically non-existent. 

Final Words 
In an environment of scarce resources, prioritisation of critical initiatives is vital to realising health goals. The implementation of Ayushman Bharat will have to be contextualised and synchronised with a reform agenda that must include improved governance and an enforcement of regulations. 

Title: Stress test 

(Water management reforms are needed to avert public hardship and economic loss) 

Context:- On the cusp of the southwest monsoon, several arid States are hoping to revive their rivers and reservoirs with bountiful rain. One of them is Gujarat, which is roiled by the long-tail effect of a deficit monsoon between August and November last year. 

The State government has embarked on a labour-intensive programme to desilt rivers and waterbodies ahead of the rains. Its predicament reflects the larger reality of drought in India, aggravated by heat waves and significant rain deficits in different regions. 

This year’s fall in reservoir storage levels to below-average levels has affected farmers who depend on the Sardar Sarovar dam, and 27 other reservoirs including those in Madhya Pradesh. 

This year, Delhi has been at loggerheads with Haryana over reduction of water released in the Yamuna, highlighting growing stresses over a vital resource. Urgent water management reforms must be undertaken to help citizens and avoid losses to the economy. 

In a normal year, the pre-monsoon phase from March 1 brings some respite(मोहलत) and India gets about 130 mm of precipitation before the rainy season begins. This year began with a sharp 50% deficit, but touched near-normal levels, though not in the northwestern region. The monsoon itself is highly variable. 

This underscores the need for comprehensive reforms at the level of States, with the Centre helping to conserve hydrological resources. If Gujarat improves rural water storage structures and creates many small wetlands beyond the compulsions of politics, it can ensure long-term prosperity for thousands of villages in Saurashtra, Kutch and the northern region where pumps run dry with unfailing regularity. 

Farmers will get relief from the monsoon vagaries that affect the Narmada, whose waters are apportioned among four States. 


Desilting of rivers: 

Desilting refers to the removal of earthy materials, fine sand etc. carried by running water and deposited as a sediment.

Vocabulary words: 

Abysmal (adj) = Extremely bad, appalling 

Gravitate (verb) = Move towards or be attracted to a person or thing 

Fragile (adj) = Easily broken, damaged or destroyed (नाज़ुक) 

Exorbitant (adj) = Unreasonably high (charged amount) (अत्यधिक) 

Lacuna (noun) = An unfilled space; a gap (कमी) 

Hollow (adj) = Vacant, empty (खोखला) 

Avert (verb) = Avoid, stave off (टालना) 

On the cusp (idiom) = At the point in time that marks the beginning of something 

Revive (verb) = Restore to life or consciousness (पुनर्जीवित) 

Bountiful (adj) = Large in quantity; abundant (प्रचुर) 

Predicament (noun) = A difficult, unpleasant, or embarrassing situation (कठिन परिस्थिति) 

Aggravated (adj) = An offence, made more serious by attendant circumstances (गंभीरता बढ़ाना) 

Reinvigorate (verb) = Give new energy or strength to 

Propitiate (verb) = Appease, calm, soothe (संतुष्ट करना) 

Vagary (verb) = An unexpected and inexplicable change in a situation or in someone's behaviour (अनियमितता)

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