National Health Policy

The challenges before the components of Ayushman Bharat, the (ir)rationality behind raising the insurance coverage manifold are highlighted, a political economy narrative of the changing health financing scenario is drawn, and how the design of Ayushman Bharat will feed into executing the proposed public–private partnership model in public facilities and facilitate the strategic purchasing agenda of the National Health Policy is examined. Ayushman Bharat is a step towards creating a system that would facilitate in relinquishing public funds and public institutions to already dominant private players, which will have serious implications for the healthcare delivery system in India.

Catastrophic household healthcare expenditure is a prominent policy concern. The National Health Policy 2017 takes explicit cognisance of this issue and presents an empirical formulation to examine its incidence and patterns. However, the policy needs to account for household size variations to counter an implicit bias that tilts the estimates to reflect a higher concentration of catastrophic expenditure among the rich. This concern is illustrated using health data from the 71st round of the National Sample Survey. Further, a minor modification to unravel the socio-economic gradient in catastrophic healthcare expenditure has also been discussed.


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Had the new health policy document proposed an overarching vision of how all the elements it enumerates would be put in place, it would have been a visionary document. As it stands the draft policy is riddled with contradictions and confusions. It spells a significant departure from the 1983 policy objectives of providing primary health care for all, specially the underprivileged. Instead of creatively utilising private sector to provide basic affordable health care, it all but hands over the task to the private sector, inevitably undermining existing national health programmes. By encouraging the corporate involvement in tertiary and secondary level medical care without first ensuring their access to the underprivileged, the draft denies the rights of the poor to good care.

Unlike the health policy of 1983, this policy attempts to address the problem of poor financial allocations for health care and recommends that it be enhanced considerably. But without a detailed exercise inquiring into the present pattern of allocations, this prescription, overdue as it is, will not serve any purpose. If the additional resources are to make an impact, considerable restructuring of the health system has to be undertaken urgently.