You can drive in your Mercedes and still be treated with same compassion and care as the poorest get!,” a very senior Health Department official said the other day when hot television debates over the new about the State’s healthcare scheme were raging on all channels. The BJP loudmouths screamed Odisha was doing wrong by ignoring the National Health Protection Scheme ‘Ayushman Bharat’ to bring in place the Biju Swasthya Kalyan Yojana (BSKY). The official explained in details how uniquely beneficial the BSKY is to every Odisha citizen vis-à-vis the Central Government's heavily-hyped ‘Ayushman Bharat' which is inextricably linked to the cumbersome and generally hostile insurance system. What most people have not figured out is that the BSKY is absolutely an ‘assurance-based’ scheme providing hassle-free service unlike the insurance route which collects a premium and never settles bills without resisting. The BSKY is perhaps the best-known welfare scheme in South Asia.
It is good to know that ‘insurance’ covers unforeseen circumstances surrounding events like fire, theft, and natural disasters. Assurance covers events such as grave illness or death. An insurance policy provides coverage for a specified period of time. But if the insured individual lives past the specified period, the insurance policy becomes void. Significantly, assurance policies will pay up anyway because the investment is combined with the sum or service promised. The State invests heavily in the BSKY and leaves the citizens to live without health-related anxiety. Assurance schemes are uncommon in the healthcare sector. Only very strong political will can instal such schemes to provide healthcare at no cost. The BSKY’s unique feature is that no one pays a dime by way of premium. The State bears the cost for every service and material good irrespective of economic status. It is evident that Naveen Patnaik was very passionate about a real good healthcare system to keep everyone fit to remain productive and happy. The poor until he came on the scene were getting financially destroyed due to expenditure incurred in buying healthcare.
lately, the Odisha Government has made all diagnostic and life support services including MRI scanning and dialysis free at the district-level hospitals. Even the nominal user fees are not collected anymore. The Government now provides free vision-corrective spectacles to students, cataract operations with top quality lenses and organises transport for patients to reach healthcare centres. All drugs, no matter how costly, are given free to even outpatients on lifelong medication due to diabetes, hypertension or cancer and more. For extra-critical free healthcare services, corporate hospitals have been empanelled to pitch in and get paid by the trust. Pregnant women in inaccessible areas now get special services to reach the nearest health centres. So, new roads are coming up fast in difficult terrain zones all over the State.
Reticent, cool but very stubborn on ensuring permanent relief to people on all fronts, particularly healthcare, Naveen Patnaik turned down the National Health Protection Scheme as that determines beneficiaries as per the grossly-flawed socioeconomic caste census data collected during the UPA stint likely to render countless healthcare seekers ineligible. Besides, the Central scheme accommodates only 61 lakh families out of 70 as poverty and other identity parameters would be difficult to satisfy. Further, the State would be forced to dish out 40 per cent of the scheme budget.
However, most reassuringly, the homegrown BSKY with a robust trust corpus will take care of all reimbursements by a failsafe management system run by highly-trained professionals. The national scheme controlled by insurance companies would make life miserable as they are known not to settle bills without trying aggressively to reject payments under some plea or the other. For this, hundreds of patients are known to have been held hostage by corporate hospitals until money landed in their hands.
The Ayushman Bharat scheme considers only eleven occupational categories eligible, thereby ignoring 90% of the urban workers. The BSKY covers all. Even the migrant workers located anywhere outside the State are entitled to all benefits. Odisha also had pleaded in vain to keep the district-level hospitals out of the Central scheme so that they could offer free healthcare, as always, to those unable to afford the insurance premiums. But the Central authorities paid no heed. They have not even made out that the identity verification procedure insisting on the Aadhaar integration et cetera would have a “burdening” effect on patients when they arrived at the hospital for emergency service. The State has already made available sophisticated diagnostic as well as treatment services in Government hospitals. Now, dialysis is absolutely free at the District Headquarter Hospitals. Spectacles for students with eyesight defects, cataract operations with quality lenses are all free. Needless to mention transportation reimbursement for pregnant women in inaccessible areas is now made instantly.
Big news is that malaria incidence has been reduced to a record low and the prevalence has gone down by 85%, an enviable achievement by any scrutiny.
The truly compassionate Naveen administration is still in limelight for providing full financial help to have the Jaga-Kalia’ brothers separated by a very complicated and prohibitively expensive surgery as the kids were conjoined at the cranium, a highly sensitive part of the head.
The State is hiring doctors at a big pace. More are to be churned out of nine new medical colleges across the State. Any health seeker visiting Government health outfits- at the district or sub-centre levels will be provided all kinds of healthcare services without worrying for money.
The most unique feature of the State scheme is that all outpatients will get lifesaving drugs and services free for life. Incidentally, the insurance companies do not pay a dime for outpatients at all. To get a reimbursement, one has to be hospitalised. A critical survey shows 60% of the health expenses are incurred by outpatients in buying drugs, diagnostics and using life support devices including MRI scanning and dialysis machine.
No insurance-linked service in India would ever give that unique benefit. It is common knowledge that insurance coverage tempts most profit-crazy corporate hospitals to suck in the entire sum assured by unnecessary investigations and specialist visits and strange acts of thieving.
Health assurance differs from health insurance in three major aspects. It promotes positive health in areas such as potable water, sanitation, environment, and agriculture, while insurance covers only clinical care for developed diseases. The health assurance scheme makes mandatory a numerically adequate, technically skilled and socially committed health workforce.
Further, health assurance provides 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”. Not surprisingly, the iconic healthcare pioneer Dr Reddy has said publicly that Odisha’s scheme is unique for having checked the most important box - universal coverage in primary healthcare and its vision. The NHPS covering only 40% of the population is not universal.
Globally-respected london-based legatum Institute has released the sixteen best nations for quality healthcare measured by three key components: • basic mental and physical health, • health infrastructure and • availability of preventative care. Their bottom-up ranking: Canada with life expectancy of 82 years; Qatar 79 years;
France 82 years; Norway with life expectancy of 82 spends the highest per person on healthcare; New Zealand maintains a life expectancy of 81.6; Belgium 81 years; Germany, despite a love of beer and sausages, is very healthy with a life expectancy of 81; Israel has the 8th highest life expectancy on the planet- 82.5 years; Australia with great weather and low pollution, enjoys a life expectancy of 82.8; Hong Kong has 11 private and 42 public hospitals to serve 7.2 million people (Women in Hong Kong have the longest life expectancy in the world); Sweden has a life expectancy of 80.7 years; Netherlands occupies the number one spot at the annual Euro health consumer index; Japan's life expectancy of 83.7 years is the highest on the planet; Switzerland is incredibly healthy with a life expectancy of 83 with a mandatory insurance coverage; Singapore, with 5.6 million citizens, boasts of a life expectancy of 83; luxembourg tops the legatum Institute's health sub-index with a life expectancy of 82.
Odisha’s BSKY assures every male a Rs 5-lakh coverage and every female Rs 7 lakh in healthcare, a first of its kind in the world for incredible services without involving thieving insurance companies.
(The writer is a core member of Transparency International, Odisha)