India’s mega health reforms: treatment for half a billion

The Lancet
Aug 25, 2018 Volume 392 Number 10148 p613-710  e7

India’s mega health reforms: treatment for half a billion
The Lancet
Technocrats and functionaries are hastily putting the final touches to India’s mega health insurance scheme following Prime Minister Narendra Modi’s announcement that the programme will be launched nationwide on Sept 25. The scheme aims to provide up to 100 million poor families with approximately INR500 000 (US$7100) in annual health insurance coverage to pay for secondary or tertiary hospital care. It is one of the components of a flagship initiative known in Hindi as Ayushman Bharat or “India blessed with long life”, which includes developments in primary health services and health promotion.

With his eyes firmly fixed on next year’s national elections, Prime Minister Modi unveiled the start date of the next part of the world’s biggest health reforms during his Independence Day speech at New Delhi’s Red Fort on Aug 15. At the same time, trials of the scheme—known colloquially as Modicare—were launched in 110 districts in 14 states and Union Territories across the country. Critics of the scheme, estimated to cost the Government US$1·7 billion in the first 2 years, fear doctors and hospitals responsible for delivering treatments will be left out of pocket. They say current Government tariffs to be offered for specialised operations and procedures—including coronary stenting—have been pitched unrealistically low.

News of the imminent launch of the secondary care scheme comes after the opening of the first so-called health and wellness centre on April 14. A further 150 000 similar facilities are planned as part of the ongoing programme aiming to provide universal health care to India by 2022. Proponents of the ambitious plans accept that difficulties might occur in the initial stages and possibly even for longer, but, they argue, to set up a system providing comprehensive health care for up to half a billion people and possibly more—the biggest on the planet—is bound to require time to bed in. Setting up such a programme has undoubtedly required heroic efforts. The implementation, running, and monitoring of the initiative will necessitate a continued commitment to ensure the fundamental right of all Indian people to adequate health care.