India’s health assurance plan will offer free medicines, diagnostics, insurance, and traditional medicine

BMJ 2014; 349 doi: (Published 03 October 2014) Cite this as: BMJ 2014;349:g6023
  1. Ganapati Mudur
  1. 1New Delhi

India’s health ministry has pledged to expand healthcare insurance to cover all citizens and make available 80 essential drugs—including 30 selected from traditional or alternative systems of medicine—to be free of cost through government clinics across the country.

The two initiatives will be key components of a proposed Universal Health Assurance Mission that will also involve nationwide “preventive health information” campaigns to promote healthy lifestyles, the Indian health minister, Harsh Vardhan, said on Monday.

Vardhan said that the health assurance mission will also guarantee a package of select diagnostic tests in government health centres free of cost to cover common illnesses. The health ministry has not released the list of free medicines yet, but senior health officials have indicated that it will include a range of antimicrobials, analgesics, antipyretics, and drugs to treat asthma, cardiovascular diseases, diabetes, and hypertension.

About 310 million people among India’s population of 1.2 billion are currently covered by government or private health insurance schemes, but most insurance plans cover only tertiary healthcare services that require hospital admissions.

Public health specialists say that free medicines could make a big difference to households.

Sambit Basu, an economist and director of research at the Infrastructure Development Finance Company Foundation, a research think tank in New Delhi that released a report1 last week on universal health coverage, said, “Even low cost but high frequency illnesses that could be managed through outpatient consultations can impose costs on households that can cascade into catastrophic healthcare expenses.”

Health economists estimate that about 70% of all healthcare spending in India is drawn from personal, or out of pocket, expenses of households. Nationwide expenditure surveys suggest that spending on drugs makes up about 66% of this out of pocket expenditure.

“The [health assurance] mission would require the central and state governments to do several things,” Basu told The BMJ. “They would need to strengthen human resources and infrastructure in government health centres, establish efficient supply chain mechanisms to guarantee that free medicines are available, and support insurance plans that would cover outpatient and inpatient services.”

Vardhan said that the universal health insurance plan would be free for poor people and would cost a low premium for the rest of the population. “We will [increase] the population of the insured rapidly; this will result in a sharp fall in premium rates,” he said.

Public health specialists say that one option for the government would be to pay the full insurance premium for India’s population below the poverty line (estimated to be about 270 million during 2011-12) and to subsidise premium payments for the rest of the population.

But experts who have been tracking the impact of India’s existing health insurance schemes seem concerned about the long term effects of insurance on the delivery of universal healthcare.

Krishna Dipankar Rao, a senior public health specialist at the Public Health Foundation of India, New Delhi, said, “We’ve found that whenever the role of insurance in healthcare expands, the funds flow towards the private sector.”

Rao and his colleagues had three years ago examined government funded insurance plans in several Indian states and cautioned that governments seem to have fallen prey to “distorted consumer demand and [a] misguided medical profession and medico-industrial complex.”2

“An expanding role for the private sector, driven by insurance, may lead to even further attrition of medical human resources, doctors as well as nursing staff, from government health centres to private hospitals,” Rao told The BMJ.

But the health ministry has announced plans to expand the role of India’s practitioners of traditional and alternative medicine in mainstream public health, and it hopes that such a move would help alleviate shortages of doctors in government health centres.

India has over 650 000 modern medical practitioners but also an estimated 380 000 practitioners of ayurveda, and over 300 000 practitioners of unani, siddha, and homeopathy, all of whom have educational qualifications recognised by the government.

Under the new plan, such practitioners who have degrees in any alternative stream of medicine (bachelor of ayurveda medicine and surgery, bachelor of unani medicine and surgery, bachelor of siddha medicine and surgery, or bachelor of homeopathy medicine and surgery) could join a one year bridge course to familiarise themselves with modern medicine and take up positions in government health centres.

Health researchers predict that the plan could pose challenges, as practitioners of different streams of medicine have largely refrained from close interactions. Devaki Nambiar, a researcher at the Public Health Foundation of India, who has published a paper3 reporting inter-system isolation and a lack of trust between streams, told The BMJ, “It is patients themselves who move from practitioners of one stream to [those of] another.”

An expert panel on universal healthcare had recommended three years ago that the Indian government should raise its spending on healthcare from 1.4% of the national gross domestic product to 3% by 2016.4 Vardhan said earlier this week that while his ministry would seek more funds for healthcare from India’s finance ministry, a renewed focus on social mobilisation through preventive health information will seek to curb the burden of diseases.

“Prevention will be the bedrock of the health assurance mission,” the minister said.


Cite this as: BMJ 2014;349:g6023


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