Why Doesn't the Indian Government Prioritize Public Hospitals Over Health Insurance Schemes?

The implementation of health insurance schemes in India is a strategic decision driven by several factors, primarily the financial and logistical challenges in adequately funding and improving public hospitals.

The Challenges of Direct Hospital Improvements

India, despite its rapid development, continues to face significant economic and infrastructural challenges. The administration's ability to provide advanced medical equipment and state-of-the-art facilities to all public hospitals is severely constrained. With thousands of hospitals spread across the vast geography, it is an unrealistic expectation to expect every hospital to be equipped with the latest technology and infrastructure.

Why Opt for Health Insurance Schemes?

The government's decision to prioritize health insurance schemes over direct public hospital improvements is rooted in practicality and immediate benefits. By promoting treatment through private hospitals, the government has targeted healthcare delivery to BPL (Below Poverty Line) and Above BPL (Above Poverty Line) beneficiaries, ensuring they receive quality healthcare.

Additionally, such schemes benefit individuals with high or middle-class incomes, as they can afford private healthcare. This not only addresses the urgent needs of the poor but also encourages affordability and promotes equitable access to healthcare resources.

The Dilemmas Faced by the Government

The main hindrances in implementing direct improvements in public hospitals are financial and human resource constraints. Addressing these issues involves time-consuming surveys, administrative processes, and ensuring accountability. The other option, providing financial incentives to private hospitals, simplifies these challenges. It is easier to manage and control through schemes like Aarogyasree, where the government can ensure that private hospitals are reimbursed for services provided.

Administrative and Political Barriers to Public Hospital Improvements

Administrative inefficiencies and political pressures further complicate the landscape of public hospital improvements. For instance, when politicians and their appointees hold decision-making powers, the focus shifts towards appointing relatives and friends rather than qualified personnel to manage these institutions. This leads to a dilution of the standards and outcomes.

In the context of private hospitals under schemes like Aarogyasree, the administrative process is streamlined. There is minimal paperwork and fewer accountability mechanisms, making it easier to bypass bureaucratic red tape. Moreover, the political leverage to influence such schemes is significant, which can be used as a tool for personal or political gain.

The allocation of funds and resources for public hospitals is often fraught with risks. There is a constant fear of decreased funds and challenges from regulatory bodies. In contrast, managing private hospitals through incentives and financial support is less risky and allows for a more flexible approach.

Conclusion

The choice between direct improvements in public hospitals and providing health insurance schemes to private hospitals is a complex one, influenced by a myriad of factors including economic, administrative, and political considerations. The current approach, while not perfect, has its merits and serves to address the urgent healthcare needs of a wide range of beneficiaries.

As the country progresses, ongoing evaluation and adaptation of these schemes are necessary to ensure that healthcare remains accessible and affordable for all segments of the population.