Is this Health care or the salvation of the insurance industry?
By Manohar Manoj 
The one who has got the highest concession in the new GST regime which started from 22nd September is health insurance. That is, the 18 per cent GST charged on health insurance has now expired. Obviously, more and more of the country’s population will turn to health insurance. At present, according to the Insurance Regulatory Authority i.e. IRDAI, about six crore population of the country which is 5 percent of the total population of the country is under the coverage of health insurance. It is quite possible that after being completely exempted from GST, more population of the country will now buy health insurance policies. But the question is whether the government wants to protect the health of the country’s population of 140 crores through a proper and complete health system or it only wants to flourish the industry of health insurance. The purpose of saying this is that any insurance, be it health insurance, life insurance or vehicle insurance or any kind of insurance, is a business which carries on the business of risk. But leave aside others; health is a human development and human sensitivity item and for any government, this is the prime responsibilities to act, to spend etc.
The concept of providing health services under the ambit of health insurance is quite prevalent in the developed countries of the West. But the point is, insurance system in western countries does not suffer from corruption and chaos in providing insurance claims or health services. Secondly, every category of disease is generally included in the scope of health insurance there. That means, the entire health system is run by the insurance companies there.
Talking about India, the health insurance business established here under the pressure of private health insurance players is full of chaos and corruption. At some places there is no cashless treatment, at some places many diseases are not included in the scope of that insurance, at some places hospitals charge arbitrary treatment bills from insurance companies, at some places patients have to make rounds of insurance companies to pay their treatment bills. Generally it is seen that doctors, on the instructions of the hospital management, incur additional expenses for the treatment of the patient and the insurance companies are not ready to bear it.
That means overall a nexus i.e. nefarious alliance is established between hospitals and medical insurance companies. Talking about PM Arogya Yojana i.e. PMJAY scheme, which was started with great enthusiasm by the Government of India, this is also a kind of health insurance scheme under which the population below the poverty line and now the senior citizens above 70 years of age have been covered. It is a kind of health insurance scheme. But in India, whether health insurance is done by general insurance companies or those covered under PMJAY , all of them bear the cost of treatment of major diseases of type-3 category and that too up to the prescribed limited level. All everyday diseases are not covered under this. In such a situation, the patient either has to become a part of the crowd of patients like sheep and goats in government hospitals or has to pay bills worth of lakhs in private corporate hospitals. At present, the basic condition of the entire health system of India is that there are few government hospitals, whether they are run by municipalities, state governments or central governments, All these are heavily loaded with the country’s population. Secondly, the chaos and mismanagement and corruption and misbehavior in government hospitals look tremendous. Despite this, there are abundance of small and big private hospitals and doctors in the country. But the irony is that the government does not mention the complete report of the overall condition of private hospitals in India under its health policy statement. They have been given freedom to loot and there is no talk of keeping them under any regulation and control. Today, when the private and public sectors have simultaneous presence under a regulatory system in every sector of the economy, then this must be brought in the field of health also.
As mentioned above, type-1 and 2 category diseases are not covered under the insurance coverage. In such a situation, it is important to mention the Central Government Health Services scheme of the Government of India, under which some special people including MPs, Ministers, Government employees have been allotted CGHS cards. Under this, government CGHS clinics have been established but also many big private hospitals have also been authorized to treat cardholders at concessional rates fixed by the government. Private hospitals say that their coming on the treatment panel of CGHS increases the number of patients and their income increases despite providing treatment, tests, surgeries and counseling at concessional rates. Now the question is what is the harm in making arrangements for the treatment of all the remaining population of the country at the same CGHS rate in these private hospitals? And why don’t governments try to reduce crowding at limited government health centers by bringing all the people under this ambit. In a way this is a win-win situation for all stakeholders whether it is government, private hospitals and patients also.
It has to be said that like the Central Government, many state governments have also started their own health card schemes. But there is a need to bring all these health card schems on the lines of ‘’one country one health card for all citizens ‘’at the entire country level. Because health is a subject in which all three tire governments; local governing body, state governments and Centre have interference.
In such a situation, the concept of a National Health Card for all daily diseases for all the population of the country will bring a big revolution in the entire health system of the country. It is worth mentioning here that some health initiatives of the Government of India have been very fruitful, in which names like National immunization program and time to time various vaccination campaigns, Mother Child Health Upliftment, contagious disease Prevention Campaign can be quoted . These government sponsored schemes have played a very important role in reducing infant mortality rate, promoting maternity health and population control in the country. Apart from this, the current Modi government’s schmes of Jan Aushadhi and Amrit Davakhanas have brought a lot of relief to the patients through providing medicines at very cheaper rates. Overall, private-public partnership is the need of the hour under a regulatory regime in all the respective field of health also. And as far as health insurance is concerned, it should be run with a better and smoother system for the treatment of type-3 category diseases. But keep in mind that these things related to humanitarian issues should not become a means of looting the profits by medical insurance companies, as we are seeing in the case of agricultural insurance also.