The Convoluted Mathematician

Since the roll out of the grand NHPS by the honourable Finance Minister in the budget I have been transfixed at the brilliance of the scheme and its design. Let us for a moment assume “x” number of surgical procedures are needed to be done for this 40 % population over 1 year. Let us assume another “y” number require to be hospitalized for medical reasons lasting an average duration of 5 days. The question which arises is how will the total expenditure on treatment change from actuals and become restricted to 25000 crore the Government has decided to spend on this insurance scheme by paying Rs 2500 for each of the 10 crore families to public sector insurers. If 25000 crore was all that was needed to provide free inpatient healthcare to all below the poverty line individuals plus those covered under RSBY, CGHS and other Government schemes totalling some 50 crore population, then India should offer to provide inpatient healthcare to the entire world because this would be the cheapest quotation ever at less than 500 Rs per person per year.

This is financial jugglery at its best. What would cost lacs of crores is being projected to be available in 25000 crore when actually the cost burden is simply being pushed on to the insurance companies which will take a massive loss. Even this 25000 crore is not budgeted in the current dispensation. Ultimately the insurers will not be able to pay hospitals for services rendered and in the chaos will be the ubiquitous “Doctor” who will be blamed for the mess. Hospitals will have to refuse to admit patients, Government will arm twist them and blame them for not giving services promised. Doctors will be further maligned and incidents of violence against them, from those who are denied services promised by the honourable Prime Minister, will increase.

I wait with trepidation for this game changer to unfold as nearly all hospitals empanelled earlier in Bhai Kanhaiya scheme, RSBY, CGHS, ECHS lost money due to bills not paid. Many surgeons did not get paid for surgeries done in these hospitals under these schemes. Only those hospitals which indulged in some kind of billing fraud in collusion with authorities could make money from these schemes in the past and the experience will be replicated many fold again. The entire credit of this scheme will accrue to the politicians in terms of votes while the entire blame will be placed on the shoulders of doctors for its failure if my assessment is correct.

Dr Neeraj Nagpal 
Convenor,Medicos Legal Action Group, Managing Director MLAG Indemnity,
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
1184, Sector 21 B Chandigarh 
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