Jaitley’s world’s largest health programme

• Universal Health Coverage (UHC) by definition means universal coverage for all medical expenses whereas this health insurance scheme covers only a part of the population (ten crore households i.e. about 40% of population) for in-patient care alone.
• Universal health insurance through private hospitals has not worked for the poor anywhere in the world. There is no substitute for public health care and this needs to be strengthened.
• The real beneficiaries will be insurance companies and corporate hospitals much more than poor people.
• There is bound to be more misuse than any proper use.
• This scheme does not address the main issue of out-of-pocket expenditure. In India, 67% of all expenditure on health is out-of-pocket and of this, 63% is on out-patient expenditure.
• National Sample Survey shows increasing out-of-pocket expenditure. The analysis of  NSS data shows that only 1.2% of the hospitalization cases of the rural population and 6.2% of the urban population received even part reimbursement from existing Arogyasree, RSBY etc schemes. They did not affect the likelihood of inpatient out-of-pocket spending, the level of inpatient out of pocket spending or catastrophic inpatient spending.
• An amount of Rs.1,200 crores for 1.5 lakh health and wellness centers works out to a meager Rs 80,000 per centre serves no purpose. This featured in the 2017 budget speech but from the experience in the previous year, it is unclear what this actually means.
• How can centre fix 60:40 sharing unilaterally? States are not its subordinates and must be consulted before finalizing any such schemes with huge burden on them.
• The centre state sharing of 60:40 doesn't have any scientific justification. It burdens states and their existing pathetic healthcare infrastructure will crumble. The ratio must be 90:10.
• The premium payable will be around Rs. 2,00,000 crores and such a large amount could be  used for upgrading and modernizing healthcare infrastructure rather than transferring to private parties.
• Accredited hospitals are highly concentrated in certain urban pockets, making it inaccessible for most of the rural poor.  
• The existing RSBY scheme with coverage of Rs.30,000 and the expenditure never exceeded Rs.500 crores in any year and these figures put the credibility of these announcements under doubt.
• This focus on insurance instead of strengthening availability of public services provides more opportunities for the private sector to make money out of poor people’s illness. 
• Budget also announces a change in the ‘health and education cess’ from 3% to 4%, and it is estimated to bring in Rs 11,000 crore where as allocation is meager Rs.2,000 crore and Jaitley is profited by Rs.9,000 crores.

Commonsense tells us that insurance and corporate hospitals could be roped in to provide specialized treatments only never universal public health care. Ignoring healthcare of poorer section during first 4 years and now suddenly shouting loudly as champions of public health care in 5th year is nothing but chunav jumla rather than any seriousness. Modalities finalization will take no less than 6 months and 2019 elections are less than 6 months away. Such election gimmicks hardly give any political benefits. This scheme may not give any real benefits. Finally, this scheme is another Modi's spectacle without any substance.