The universal health insurance scheme launched by the government is an ambitious plan to not only give residents of Goa free access to quality healthcare in the private sector, but also indirectly bring about standardization of rates for medical procedures, which seem to vary from one facility to another. The scheme is not unique because the previous Congress government had
launched a similar one, but with a lower slab of Rs 60,000 per family. The Deen Dayal Swasthya Seva Yojana scheme will provide insurance coverage of Rs 2.5 lakh per year to a family of three and Rs 4 lakh for a family of four which is more realistic.
Schemes of this sort were launched by some states at least
four years back for families living below the poverty line, and
hence the present scheme is, more or less, an extension of existing
ones.
The new health insurance scheme will cover 447 medical
procedures of which 278 are available at the Goa Medical College.
However, patients can seek
treatment for any of the procedures
at private hospitals which are empaneled.
The insurance provider
will empanel a minimum of 25 hospitals
and grade them according
to facilities available. A rate chart
prepared with inputs from AIIMS,
North Eastern Indira Gandhi Regional Institute of Health and
Medical Sciences, Shillong, Tata Memorial Hospitals and
Christian Medical College and Hospital, Vellore, will form the
backbone of the scheme and empaneled hospitals will have to
bring their rates in line with these to enjoy the benefits arising
out of the scheme.
Apart from being a boon for residents who will be able to access
healthcare at a hospital of their choice without having to
pay, the scheme will also benefit the private healthcare sector.
With a healthcare insurance card in hand that enables spending
up to Rs 4 lakh, where is a patient more likely to go? It is obvious
that he or she will choose the private sector. The scheme,
once fully operational, will move a lot of patients from public
hospitals to the private ones, provided they abide by the rate
structure set by the insurance provider. The scheme is formulated
in such a way that those who stay out will stand to lose
patients to empaneled hospitals. In the long run, the insurance
scheme will bring about a standardization of facilities
and rates across the sector, which will benefit patients and
hospitals. The private sector has grown on the back of medical
insurance and this scheme will spur growth with hospitals upgrading
facilities to make it to the ‘A’ grade which will benefit
from higher rates.
The insurance scheme is likely to have a significant impact on
the Goa Medical College. With cost no longer a factor patients
will start migrating to the private sector. If the GMC is starved of
patients then it will affect its status as a premier medical institution.
On the other hand if the number of patients reduces, it
will give GMC doctors and administration room to breathe and
refashion the facility into a better institution.
Having put together a complex scheme, success now lies in
implementation and this is where the scheme could prove to
be beneficial or come apart. The government must monitor
progress of the scheme at every level for universal health coverage
to be realized.
