It is a matter of great regret and surprise that governments at both the central and state level confuse public health with individual health. There is plenty of heartburn with state level health schemes ( like the ‘Arogyasri scheme’ in the two Telugu speaking states) and central level schemes like ‘Ayushman scheme’, amongst the doctors. The packages fixed for various diseases are random, low, and many times, irrational. Mostly, the packages do not work; and when they do, it is after cutting a lot of corners. Among a host of issues with these government sponsored insurance schemes, the major, of course, is the non-payment or extremely delayed payment of the dues. The infrastructural and material costs run very high in managing patients even if one completely ignores the service charges of the doctors. At one breaking point of time, the scheme becomes unsustainable for any hospital.
Similarly, the scheme is generally unsustainable for any government as it is a one-way street of gross expenditure. The returns are only perhaps in the form of votes from the citizens but does nothing to public health. For delivery of public health and improving the pathetic numbers we have today in terms of health indices like Maternal Mortality Rate, Infant Mortality Rate, and so on, we need a health pyramid where doctors occupy a small space at the very top of the pyramid. The broad base consists of measures like good roads, sanitation, covered drainage, mosquito control, and a good water supply amongst other things. Then the whole organization of the health delivery system starting from the Primary Health Centers to the tertiary level hospitals. Specialist treatments play a small role in this set-up to improve public health and the shameful health indices. Sri Lanka seems to do better than us in these indices indicating the health of the nation.
In individual health too, the doctors are important, but again there is a hierarchical health delivery system starting from general practitioners, and then working up to higher levels culminating in the super-specialists. It is a peculiar and ironical situation that after decades of faulty planning and faulty understanding of the lay public, the whole pyramid in individual health has inverted. Unfortunately, super-specialists are today at the base of health care as primary providers. Similarly, in public health too, the health pyramid has totally inverted where the doctors have become the base and the scapegoats for everything which has gone wrong with the system. The primary problems with the collapse of the public health system lie elsewhere, which should ideally be a moment of introspection by governments past and present. The whip unfortunately falls on the doctors.
It would be interesting to have some numbers at this point of time, almost a decade after Arogyasri in the Telugu speaking states, as to how it has impacted the health indices. It would be surprising if there is something positive as a direct outcome of this scheme. Catering to individualised specialist care is hardly a solution to the country’s health problems. Finally, the scheme becomes a big, white elephant; and it is impossible to throw it out of the window. For successive governments, these insurance schemes become something like the reservation issue- impossible to touch or reform. Individuals may benefit from specialist care at ‘good’ centers, as is the focus of these unsustainable schemes. However, the same does not hold true for the overall health of the country.
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