Odisha Chief Minister Naveen Patnaik last week announced that under the new Biju Swasthya Kalyan Yojana (BSKY), “everyone visiting any government health institution from district to subcentre level will be provided all health services free of cost”. The Odisha BJP has since been arguing with Patnaik’s BJD over the relative merits of BSKY and the Centre’s Ayushman Bharat Yojana or National Health Protection Scheme (NHPS).
BSKY vs NHPS
“The fundamental difference is that the Centre’s scheme is insurance-based, while Odisha’s is a health assurance scheme,” BJD Rajya Sabha MP Pratap Keshari Deb said. Union Petroleum Minister Dharmendra Pradhan retorted that it was Dr K Srinath Reddy, the Odisha government’s own honorary health adviser, who had praised the Prime Minister for “emphatically moving the discourse from health insurance to health assurance”. (Opinion in The Indian Express, July 10, 2014)
Assurance vs insurance
Reddy wrote in this piece that health assurance differed from health insurance “in three major ways”. One, it promoted positive health in areas such as potable water, sanitation, environment, and agriculture, while insurance covered “only clinical care for developed diseases”. Two, health assurance required “a numerically adequate, technically skilled and socially committed health workforce”. Three, health assurance provided “cost coverage through a combination of several financing mechanisms”, including tax-funded free essential health services to citizens, employer-provided health insurance for additional services, government-funded social insurance, and private insurance for those who wanted it, “all or most of these… routed through a single-payer system”.
In a telephone interview this week, Dr Reddy said “Odisha’s scheme has checked the most important box — universal coverage in primary healthcare — and its vision seems to be progressing towards health assurance”. The Centre’s NHPS “covers 40% of the population, and is not universal in that sense”, he said.
Who exactly gains?
Earlier this week, Patnaik wrote to Prime Minister Narendra Modi saying “the dependence of NHPS on SECC (socio-economic caste census) data will be a serious handicap” because “the SECC survey done on the criteria fixed by the UPA Government has grave lacunae and many genuine poor have been left out”. BJD’s Deb claimed that while “the Centre will register 48 lakh families in the first phase and raise it to 61 lakh in subsequent phases, we will cover 70 lakh families directly”. The BJD’s estimate of 70 lakh families is based on services provided under the Rashtriya Swasthya Bima Yojana (RSBY), Biju Krushak Kalyan Yojana (BKKY), Odisha State Treatment Fund (OSTF) and Chief Minister’s Relief Fund (CMRF).
Pradhan, however, argued that the SECC list has been provided by states themselves. “The Odisha list has been made by the Naveen Patnaik government. The Centre is using the list you (Odisha) have submitted,” he said.
Costs and benefits
While the BJP says BSKY puts needless pressure on the state budget, Deb said the Centre’s scheme too, requires states to pay 40% of costs and, “if you factor in costs of identifying beneficiaries through a survey and implementing the scheme, the state will have to anyway shoulder 50% of the cost.”
BJD also claims that the NHPS will involve insurance companies, whereas beneficiaries of the state scheme will receive reimbursement “directly” from the government. “Under existing mechanisms, when a patient requires funds up to Rs 1 lakh, the district collector releases it directly, and funding between Rs 1 lakh and 3 lakh is approved by the OSTF section and released within 12-15 days. BSKY will set up a similar speedy modality. Insurance companies take months to pay up,” Deb said.
A central government press release has said that “for urban areas, 11 defined occupational categories are entitled under the scheme (NHPS)”. Deb said “this will require a specific survey, leaving out 90%-92% of urban workers. The state scheme does not make such differentiation.” Pradhan said: “Ayushman Bharat can apply beyond the state’s borders and will specifically help migrant workers who work outside Odisha.”
Whose scheme is it?
Pradhan alleged that the Naveen Patnaik government was upset because “the Centre’s scheme does not allow anyone’s name to be attached to it”. Odisha has named several schemes after Naveen’s father Biju Patnaik.