While it is reassuring to know that the insurance scheme will come with a robust mechanism to avoid fraud and misfiring, one can easily question how stable and fiscally sustainable it will be, given our reluctance to invest enough in public health.

The scheme will quite possibly require increasingly higher allocations in the coming years, alone consuming the larger share of our total government spending on health. Uncertainty looms over the fate of public hospitals which now could be held responsible for their own solvency, and may fail to compete with private hospitals despite protection.

Also, the initial outlay for H&W centres (1200 crores) is anything but encouraging, and easily more than 10 times the present amount may be needed to run a well-equipped and responsive H&W centre. It will be interesting to see how things evolve and challenges are tackled in the forthcoming years.

The measure seems politic considering that little could be achieved despite the MCI being placed under supervisory bodies a number of times since the year 2000, including in 2016 and 2017, when oversight committees were constituted to oversee the functioning of the council, but the MCI was accused of noncompliance with the committee’s directives.

But the bigger question remains: how effective will the new body (NMC) be after it comes into existence?

While the announcement of the NMC bill caused a furore among doctors initially, on account of doctors being inadequately represented in it, the current version of the NMC bill proposes 20 out of 25 of its members to be doctors, making it little different as far as representation is concerned from the MCI, which was criticised for not having representation from the patient community and was accused of working solely to protect doctors interests.

The reform is like a breath of fresh air for the outmoded curriculum. For long, experts and advocates have been advocating for training on essential communication skills and medical ethics to be made a prominent part of the curriculum, especially given the complexity of present-day medical care. However, certain fundamental challenges exist on the ground to its effective implementation.

Today, medical college-hospitals present largely unsuitable environments for the faculty themselves to exercise communication skills in their practice, let alone attempting to inculcate such skills in students. Also, the relative laxity with which practical classes and exams are mostly conducted and an unfavourable theory-practical balance could become impediments to the inculcation of soft bedside skills. Not to mention that the medical practice ecosystem itself is hardly conducive to ethical behaviour.

Even though only time can tell how much of this will fructify, if one considers the developments of the last few years, an encouraging trend appears: that of focussing on large-scale preventive health drives. The Swachh Bharat Abhiyaan and the Intensified Mission Indradhanush have been reasonably successful in addressing primary concerns like open defecation and missed immunisations, considering their limited time frames.

It is essential that higher expenditures in health give primacy to primary and preventive care and don’t get channelled into wasteful and less-efficient areas. The same will also contribute to ensuring that successes achieved through temporary preventive programmes operated in mission mode are sustained in the long term.

It is a welcome fact that the list, comprising 130 general and 26 specific tests, covers the primary and secondary care level rather than unrealistically aspiring to cover high-end tests. The challenge lies in effectively making these diagnostic services available across government health centres and hospitals, an area in which we fare poorly today.

It also appeared earlier this month that four new medical devices will now be included under the Drugs and Cosmetics Act, making them amenable to quality and price regulation. That boosting the domestic medical devices industry appears to be a priority for the government is commendable, given our high reliance on imported devices and the fact that this measure could help bring down their prices.