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.
