In 1997, my mother, who was a class one government employee, died of T4 stage cancer. In the 1 ½ year of cancer treatment, we had spent all the money, and we became a BPL family (below poverty line) in a matter of hours of her death, when we had the dead-body, but no money to do her last rights. Last year, it was reported that, 50 million went below the poverty line due to healthcare costs. Healthcare expenses can be devastating and can push a family back by decades.
PM Modi is quite serious about healthcare and has launched the NHP (National Health Policy) in 2017, and in 2018, NHPS (National Health Protection Scheme). These two steps are the boldest steps in the history of healthcare reforms in India. If one looks at the overall vision of the government for healthcare, it looks like a perfect solution to tackle the complex healthcare challenge which a large LMIC country like India faces.
On one side, there is a plan to have NHPS for 50 crore population and 150,000 Health and Wellness Centres, these centres will act as a gate-keeper. On the other side, the government is committed to immunization programs, Swacch Bharat mission, expanding the low-cost pharmacy chains, national screening programs, National Nutrition Mission, and provisioning for nutrition of those suffering from tuberculosis. Also, the ministry is working on setting up health helplines, wherein, people can talk on a toll-free health helpline and seek advice / medication for acute ailments requiring OTC products and guidance for treatment of other ailments, based on standard treatment protocols. So, if we look at connecting all the dots in the budget and various programs of the ministry; one will be convinced that this budget is the ‘budget for health’ in the past seven decades, and the government has got a comprehensive plan to address the challenges of healthcare.
Health – a Unique Economic Proposition: All throughout, we have been listening about how healthcare will impact the lives of poor, and two years ago, when I authored a book on “Healthcare reforms in India-Making up for the lost decades”, I dedicated the first chapter on how healthcare is a unique electoral proposition (UEP), and how political leaders across the world- be it U.K. or the USA, have made healthcare as a key electoral strategy and won successive elections. What a coincidence that NHPS scheme also comes a year before the general election. But, we must look at the other side as well. On the face of it, looks like this scheme is all about healthcare, but from an economist’s lense, I get reminded of this quote, “In health, there is wealth’. Just consider the following statistics
a) healthcare is the largest employer in the United States
b) Over 40 million new jobs are expected to be generated in the next two years in India by the healthcare Industry
c) for a crore rupee invested in any sector, healthcare creates highest number of jobs directly and indirectly. Also, healthy workforce is an economic asset and an unhealthy workforce is an economic liability. We cannot afford to grow at double digits without investing in health and education.
Now, let us examine the economic impact: For rolling out of this scheme that takes care of secondary and tertiary care inpatient services, it means that there will be utilization of services and infrastructure which probably will need massive investments and scale up in the next decade. For every Rs. 10,000 of healthcare services provided; there will be a need to create such infrastructure, and a need of utilization of logistics (travel of patients, products and this will prop up the logistics industry). Also, IT will get a big boost due to its integration across the continuum of care; professionals like nurses, doctors and other allied professionals will be needed, which means more institutional capacity will be created to cater to the increased demand. More beds will mean more investment to produce them! Medicines, medical devices, consumables, hard infrastructure like hospital building, will grow the reality sector, which means associated industries will grow commensurately. Hence, availing just Rs. 10,000 worth of inpatient services under the NHPS, will call for at least 100 to 1000 times the investment in healthcare. So, without doubt, I can say, that this one insurance scheme will lead to at least an additional investment to the tune of 100 billion dollars in this Industry and to our economy. Investors are in a rush to maximize the best out of this opportunity, and to realise the growth potential in healthcare services and in medical tourism. With NHPS, this sector becomes most attractive where the ‘strategic buying’ will be done from the private sector. This sector will witness the highest growth in terms of investment and employment. So, this is not just a healthcare reform, it is also a massive economic and employment reform.
There is an interesting case study of Muni Seva Ashram Hospital in Goraj (Gujarat), on how a hospital can prop up a complete economy. This hospital has created a self-reliant model for about 50 Km radius. Post the launch of NHPS, we will see a jump in FDI in this sector at least 10 times for the next few years. So, the flawless implementation of the scheme will pay rich dividend to the nation’s economy.
Regulation & oversight is important: Enough checks and balances have to be inbuilt to ensure that there is no misuse, cartelization and lobbying in healthcare. Else, the very purpose of the scheme will be defeated. We need to look at case management protocols (symptom based diagnostic protocols), screening guidelines for all age groups, diagnostics and treatment guidelines with proper decision support systems using information technology. With NHPS, the healthcare rates are likely to fall and the utilization likely to increase drastically as economies of scale will come into play. Right now, some reports indicate that about 40 percent of the population cannot afford healthcare when it comes to secondary and tertiary care. This insurance scheme will bring them under the net to avail the services, which means the industry is likely to grow phenomenally. This also calls for self-regulation by the industry, and oversight from the regulators. A lot is in for store for all in healthcare and the economy, and the right and timely implementation will make all the difference. Our PM has taken a biggest bet on healthcare in the election year, and the Government has got the right strategy on healthcare, and now, it is for the administration to deliver and to realise the grand vision of PM Modi, and there are enough reasons to cheer about the success of NAMOCARE.
(Rajendra Pratap Gupta is a public policy expert & author. Currently, advisor to the Union Health Minister.Views are personal)