In the interim budget 2024, government announced the expansion of insurance based health care scheme Ayushman Bharat to cover ASHA and Anganwadi workers. Scores of women employed in these low paying, contractual jobs are the lifeline of National Health Mission, however up until now they themselves had no health cover from their employer, that is the Government of India. But, coverage under insurance based health scheme was not their demand. Their demand is to be treated at par their permanent counterparts, for they know very well that insurance schemes do not serve the people.
What is the problem with private health insurance?
A private insurance company providing a health insurance is just like any private company– it needs to make profit. But how is this profit made? An insurance company makes profit in 2 ways: (i) it makes money from the premium paid and (ii) it invests this money to make more money. Profit can only be high if only a small percentage of the insured persons fall ill. This model of profit making collapses when the insured person is poor. The probability of the poor falling ill is much higher than the rich. Thus, insuring the poor is bad business. Yet companies enter this business given that it ensures bulk premium usually from the government. In that case, profit can only be made through rejection of claims. In fact, insurance assessors are incentivised for the number of claims they reject. Even the economic survey of India (2021) acknowledged that India has one-of-the highest level of Out-Of-Pocket Expenditures on healthcare, despite being covered under government insurance schemes, pushing families into poverty.
The answer to the failure of this profiteering model is free and universal healthcare for all. However, the argument that all governments give its people, and we have almost begun to believe them, is that it is very costly for government to provide free healthcare for everyone. Many governments have thus resorted to health insurances as a replacement to universal free healthcare. The US welcomed insurance based Obamacare and we got Ayushman Bharat. The world has changed so radically that even our trade unions today demand greater coverage for their members under these schemes, instead of demanding universal free healthcare.
Is universal free healthcare even possible?
Well, the answer is YES! The Caribbean country Cuba has shown us a successful model. Its health policy strives to convert medicine “…into a science that serves to prevent disease and orients the public toward carrying out its medical duties. Medicine should only intervene in cases of extreme urgency, to perform surgery or something else which lies outside the skills of the people of the new society” (On Revolutionary Medicine, Dr. Ernesto Che Guevera, 1960) and ensures health as a human right for all citizens, not just for those who can afford it.
How did Cuba achieve this?
Free education: Every child has access to free education. With an emphasis on healthcare, large number of students enroll in medical education. Consequently, doctor, nurse to patient ratio is very high. As part of education, medical and healthcare students are taught ethics and values alongside science and technology. Students graduate with a commitment to providing and preserving quality and equity within healthcare for their communities.
Healthcare Campaigns: Healthcare is considered a universal human right. Community campaigns for universal vaccination, maternity and prenatal care, sex education act as key components of preventive care with active participation of the community leading to reduced healthcare costs.
Community clinics: The neighbourhood is treated as the centre of public life. Primary healthcare is delivered at neighbourhood polyclinics equipped with doctors, nurses, basic diagnostic facilities and statisticians. The polyclinics also act as research and teaching centres for medical, nursing and allied health sciences students. The polyclinic also relies on active population screening for a clear community health diagnosis to ensure preventive care.
National Health System: The government takes all financial and administrative responsibility for healthcare of all citizens. There are no private hospitals or clinics. The advanced national healthcare system also acts as a site of ‘medical tourism’ thereby earning valuable foreign exchange.
Research and Development: The healthcare system is continually involved in improved use of technology, training and ongoing renewal of human capital, as well as the system’s capacity to gather and analyse available information and to conduct monitoring and evaluation, and reduction of cost of healthcare.
Production of essential drugs and equipment: The country also produces essential drugs, and medical equipment in the public sector in order to ensure that its citizens have access to lifesaving drugs and vaccines. Critical investment is made in indigenous R&D which is then tested and bulk produced for the country. These products are also exported for foreign exchange.
It is a model that can be easily replicated in our country too, if the government shows the will to serve all its people and not just a handful of corporations.
Leave a Reply