The Hindu Business Line : Health cover realities

THE CENTRAL GOVERNMENT'S proposal for a National Health Insurance Scheme for families living below the poverty line could end up becoming a public administration disaster. Given its dire implications for leakage of funds, it could make the Bihar fodder scam seem like a petty case of cattle theft in a village fair. The proposal involves the Centre contributing to the premium for insurance cover from public sector general insurance companies, against medical contingencies requiring domiciliarytreatment. The official record, both at the Centre and in the States, in effectively administering any sharply targeted welfare scheme, has been extremely poor. Whether it is rural employment or public distribution of foodgrains or schemes for providing basic education, most welfare schemes have run into complaints of mis-targeting of beneficiaries, besides administrative corruption.

The administration of a comprehensive health insurance scheme for the poor is unlikely to be any different. More so, where the scope for misuse is immense. The insurance companies have for long been helpless in taking any remedial action despite strong evidence that those insured under medical insurance policies, more often than not, collude with medical practitioners and dispensing chemists to prefer fraudulent claims. The potential for misuse can only be larger if the scope of the scheme is substantially enlarged, as proposed now. The scheme also presumes that medical infrastructure already exists at the village level and it is only affordability that inhibits public access to quality health care. But this runs counter to the widely-held perception that primary health centres are under-staffed and medical practitioners do not wish to go to rural areas. In the absence of medical infrastructure, even those who are innately honest cannot be blamed for seeing the scheme as nothing more than a licence to make money out of the Government and staking a claim to a share of the pie.

Then there is the aspect of costs. It is by no means certain that the official estimate of 260 million as the number of people living below the poverty line is indeed accurate. Also, the eligibility criterion of population living `below poverty line' may be harsh on that segment that barely manages to eke out a living above subsistence level but has otherwise no access to healthcare of any sort. The Government may find it difficult to deny this group the benefit of health cover. In the event, the universe of covered population could be significantly larger than the current official estimate. No doubt, the economic argument for direct intervention by the state in such sectors as health or education or even poverty alleviation is by now so well-established that it is no longer a case of economic growth eventually making a difference to the lives of the poor. But romantic notions of social welfare should not dictate public administration policy as much as a realistic appraisal of what is feasible and an abiding commitment to getting the best value for every rupee in the public purse.