Who will bear the fee of healthcare for India’s elderlies, including probably the most vulnerable? The primary study on Publicly Funded Health Insurance (PFHI) – which is to be differentiated from direct provision of healthcare services through public healthcare hospitals – of the elderly, based on 2017-18 data (before the launch of PM-Jan Arogya Yojana (JAY) raises red flags.
Within the context of ‘catastrophic health expenditure’ – health spending is taken into account catastrophic when it accounts for 25% or more of the whole yearly consumption spend of a household – it reveals that PFHI was not effective in protecting the elderly financially. With limited income, out-of-pocket expenses can exacerbate financial insecurity, resulting in non-adherence to medication and deterioration of healthcare access. The study blames poor regulation of personal healthcare for the sorry state of affairs.
Financing and managing healthcare higher, proper regulation of personal healthcare services, and fixing the creaky public healthcare system needs to be the goals. In a conventional insurance scheme, where hospitals are paid for treating people, the incentives for care-providers and insurance firms are misaligned. Care-providers seek to use their take, pushing up expenditure on investigations and unnecessary procedures while insurance seeks to lower its payout.
A greater option to structure incentives could be to pay a care-provider a per capita fee to supply care to an outlined population. Actuarial expertise could be used to estimate the fee it takes to maintain an individual healthy and treat her if she falls sick. It will minimise costs. Promoting homecare for the elderly, as is prevalent in Japan, can also be a great idea and calls for augmenting healthcare manpower.