[The program gives poor families insurance of up to $6,950 in hospitals, a significant sum in India. For primary care — basic services usually provided by general practitioners or nurses — the government plans to open 150,000 “health and wellness” centers, staffed by nurses, traditional medicine healers and other health workers, by 2020.]
By
Vidhi Doshi
 |
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Indian
Prime Minister Narendra Modi is making a new health-care program a key
plank of
his platform for elections next year. (Sony Mehta/Hindustan Times
/Getty Images)
|
NEW
DELHI — Personalized letters
from Prime Minister Narendra Modi, announcements from door-knocking health-care
workers and lists pinned up at village council offices trumpet the news:
India’s vast new health program has arrived.
Starting Sunday, half a billion Indian
citizens will be covered under an initiative that local media have dubbed
“Modicare.” Although nobody seems to be sure whether it will work or how much
it will cost, the government has touted it as the world’s biggest
government-funded health scheme.
“Indian healthcare is poised for a great leap
forward with Ayushman Bharat — which will insure over 50 crore [500 million]
citizens,” tweeted Health Minister Jagat Prakash Nadda, referring to the
program by its official name, meaning “Long Life India.”
Decades of explosive economic growth have
brought new wealth to India, but the neediest of its people still lack basic
services. The health-care plan, targeted at the country’s poorest 40 percent,
will be a key plank of Modi’s campaign platform in national elections next
year.
Experts say the political momentum behind the
program is unprecedented and promising. The British medical journal Lancet
published an editorial praising its ambitious scope: “Setting up such a program
has undoubtedly required heroic efforts,” it said.
There are fears, however, that new demand
created by Modicare could place even greater strain on India’s already
stretched health infrastructure.
[India turns to public shaming to get people
to use its 52 million new toilets]
The program gives poor families insurance of
up to $6,950 in hospitals, a significant sum in India. For primary care — basic
services usually provided by general practitioners or nurses — the government
plans to open 150,000 “health and wellness” centers, staffed by nurses,
traditional medicine healers and other health workers, by 2020.
The plan leans heavily on partnerships with
private hospitals and will promote traditional ideas of holistic health care,
such as incorporating yoga into daily routines.
“It’s a very, very Indian program,” said
Vinod K. Paul, a pediatrician turned government official and the program’s
creator. He declined to say whether any aspect of it was modeled on health-care
systems elsewhere.
Paul said that most of the plan represents
uncharted territory for the Indian government and that Modi had essentially
signed a blank check to make it work. The final budget, he said, is difficult
to pin down because nothing like this has been attempted before. The government
has allocated $4.8 billion for now, but the treasury has committed to providing
more on request, he said.
Reforming health care in India is a mammoth
task. According to a 2010 study, more than 63 million Indians fall under the
poverty line every year because of health costs. In most states,
government-funded hospitals are understaffed and ill-equipped, so many people
end up paying for expensive private care.
On a recent afternoon last month at
Safdarjung Hospital, a government facility in New Delhi, dozens of people were
camped outside, bedding down on mattresses and plastic sheets for days while
they or family members were treated inside.
At Safdarjung, beds are in short supply,
doctors work long shifts, and patients cry as surgery dates are delayed.
“We have been sleeping here for the past
eight days,” said Mamata Devi, a young mother who had traveled more than 24
hours by train to get to the hospital after her 6-year-old daughter
accidentally drank cleaning liquid. The child had been treated but needed
follow-up care.
“When it rains, we sleep there,” Devi said,
pointing to a small roof at a side entrance to the hospital.
Devi spent about $60 on travel from her
village. Food costs her an additional $3 a day. Her husband makes about $4 a
day selling utensils. “We will spend the next year or two paying back the
loan,” she said.
Under the new program, Devi’s daughter might
have been eligible for free treatment at a private hospital closer to home.
Moreover, government hospitals like this one
stand to receive additional payments for every Modicare patient they treat,
meaning that they might be able to upgrade their facilities.
Paul, the government official, said the
health plan is focused on reducing “catastrophic spending” — when families have
to spend more than a quarter of their incomes on health costs. In poor
families, he added, that usually happens when a patient is hospitalized.
“If a rickshaw driver’s wife gets cancer, he
has no choice but to sell his rickshaw,” he said.
Some experts say the program focuses too
heavily on hospitalization and neglects primary health care — the basic
general-practitioner services that many argue are the bedrock of a robust
health-care system.
Paul disputed that, saying that the
government has a “profound commitment” to primary care. Nurses and
practitioners of traditional Indian medicine will take “bridge courses” to
enable them to provide services that include diagnosing some cancers and
tuberculosis. When diagnoses are complicated, health-care workers can
video-call a doctor for advice. Government-backed awareness drives and “people
movements” on health issues such as nutrition will be added to existing
services.
It’s not an ideal situation, Paul conceded,
but he predicted that new demand would create growth. “Everybody knows we have
to build our health-care sector,” he said, adding that the need to care for
India’s poor is urgent. “We can’t wait for the perfect moment.”
There are other potential hiccups. The
government will pay public and private hospitals fixed rates for treating
people covered under the program. So far, 15,000 hospitals — a mix of
government and private — have applied for government certification, Paul said.
But the government’s rates are much lower
than the prices that private citizens pay, experts said, and there is a
shortage of applications from hospitals that can provide complex surgeries.
“Private hospitals are not happy but have
accepted because the government has convinced them to help them with the
launch, and then revise rates next year,” said Srinath Reddy, an adjunct
professor at Harvard University and president of the Public Health Foundation
of India.
Paul said this is only a first step toward extending
affordable care to the country’s entire population, now estimated at more than
1.3 billion. “These are difficult things that India’s trying to do,” he said.
“But we want every poor person to be able to get treated. Isn’t that your
dream?”
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