National health entitlement card
Working towards its aim of providing free healthcare to all, the government is planning a national health entitlement card (NHEC) for every citizen that will guarantee access to a package of essential primary, secondary and tertiary healthcare fully funded by the Centre. The proposal, finalized by a high-powered expert panel of the Planning Commission, talks of covering both in-patient and OPD services free of cost with cashless facility. The health package will focus on the most common and high-impact healthcare requirements. While the Centre will bear the cost of services offered under the national health package, state governments can add more services at their own cost. The health services can be availed through public sector and contracted private facilities, including NGOs and non-profit agencies. Service providers, be it public or private, who accept the health card will not provide any services to those willing to pay additional fees either out-of-pocket or through their privately purchased insurance policies. This is being done to keep away those who can pay to avail health services. For services outside the national health package, people will have to pay from their pocket or through their insurance policy. These services can be made available at facilities which do not accept national health card. The expert group has called for universalization of healthcare, suggesting that public spending on health be raised from around 1.4% of GDP to at least 2.5% by the end of 12th five-year plan (2012-17) and at least 3% by 2020 to achieve the objective of healthcare for all. Justifying the hike in public spending on health, the panel said, “Enhancing public expenditure, by reducing private out-of pocket expenditure, is likely to have direct impact on poverty reduction.” Arguing that use of insurance companies to purchase healthcare on behalf of the government will not be very fruitful, the panel suggested integrating all government-funded insurance schemes with universal healthcare and replacement of all health insurance cards by NHEC cards. The panel said technical and other capacities developed by labour ministry for management of the Rashtriya Swasthya Bima Yojana should become the core of the universal healthcare operations and could be transferred to the health ministry. The panel suggested focussing on extensive and high quality primary care network and argued that this would result in fewer secondary and tertiary facilities being needed.