Its’ been a fad in Indian politics since the summer of 2014. It’s called Gujarat Model. Slickly packaged, media swooning over it and the idea unchallenged. Only one thing though. The Truth far-fetched and the deliveries suspect. From PM (of India) to CM (of Goa) to now Health Minister of Goa, the fascination with Gujarat Model is a weird game of me too. So when the State’s topmost Health Policy Maker announced a team to travel to Gujarat and ‘study’ their Model of Health Insurance last week what went unchallenged was his whole premise of choosing his benchmark. Was it that Gujarat really boasts of the country’s best model or was it just another new Congress converts to BJP turning Bhakt of anything that has NaMo connected with it? The later quite possible because Gujarat isn’t the country’s best healthcare or even health insurance model isn’t the best in the country. Who says so? Niti Aayog says so.
As per Niti Aayog Health Index (2015-16 vs 2014-15), Gujarat slipped down two places and stood behind Kerala, Punjab and Tamil Nadu (all non-BJP states) amongst the big states. Goa as a small state stood 5th after Mizoram, Manipur, Meghalaya and Sikkim. The target of larger states like Gujarat is not the same as smaller ones like Goa just as an apple and an orange cannot be compared but for those who would like to compare it, Goa (with 53.13 points) stood higher than Gujarat (with 37.96 points). Goa’s Health Minister seems to be like his Cabinet colleagues more interested to court mediocrity than getting the best for Goa. So who should we have rather studied as a Model for Health Insurance as a small state? Mizoram.
Mizoram has two distinct healthcare insurance schemes. For families below poverty line (BPL) a Rs 3 lakh comprehensive health care insurance coverage and for those above poverty line Rs 3 lakh for identified critical illnesses (over 100 illnesses and conditions). Their health insurance cover benefits include Hospitalisation up to Rs 1 lakh coverage for meeting expenses of hospitalisation and surgical procedures for BPL beneficiaries, Rs 3 lakh coverage for APL and BPL for Critical Illnesses, Expenses of travel with one attendant. Maximum Rs 1000 within and Rs 10000 for out of State. Mizoram’s Pre and Post hospitalisation coverage includes pre-admission investigation and post-hospital medical experience for up to 10 days, Daycare procedures covering outpatient services such as radiotherapy, eye surgery etc and all pre-existing conditions covered with minimum exclusion. If you want to fall ill, Mizoram is the place because even for high-grade fever, there is insurance.
In contrast, Goa’s Deen Dayal Swasthya Seva Yojana Insurance fails on the account that premiums are higher per head as the population is too small, cost of many treatments under DDSSY is too less, therefore, hospitals reject the treatment, the recent tie-up with KLE (without offering level field to others) is a cause of severe hardships to families both physically and financially is you notice as compared to Mizoram above. Then there is a lack of awareness of the scheme. No promotion at Panchayat level, The scheme doesn’t cover hospitalisation due to fever and other non-surgical illnesses which incur high treatment costs including ICU and suffers as it is not a government-run corpus fund administered professionally by a private company.
But then Hon’ble Health Minister does not seem to have read Union Ministry of Health & Family Welfare’s guidelines for a flawless and delivering healthcare scheme enshrined in Framework for Implementation for National Health Mission 2012-2017. It prescribes reduction of financial barriers to healthcare, improving access to healthcare, reducing distress by reducing out of pocket expenditure, protecting households from catastrophic health expenditure but first and foremost, improving quality of healthcare. The Minister rather than competing with and marginalising private healthcare sector in Goa by dabbling in super-specialisation should look at the basic that Goa needs ranging from improving the proportion of vacant healthcare provider positions (regular + contractual) in public health facilities (which is just 23%) to hastening transfer of healthcare delivery funds – it takes five months (154 days) on an average to transfer Central National Health Mission funds from State Treasury to implementation agency (Department/Society) based on all tranches of the last financial year. The Health Minister should first get the basics in his house in order before chasing quixotic targets.
Gujarat Model may get him his Cabinet ambitions realised but it definitely isn’t making Goa healthier.
