Take any parameter—India has one bed for every 1,050 patients as compared to Japan’s 85 and 350 in the US and just 0.7 doctors and 1.5 nurses per thousand people whereas the WHO prescribes 2.5 doctors and nurses on an average—and it is obvious the country’s healthcare model isn’t working. Which is why, the NDA’s National Health Policy talks of raising government healthcare spending, from 1.3% of GDP right now—government expenditure comprises around a third of the total in the country—to around 2.5% by 2020. Since getting to that target means spending money the government simply doesn’t have—the policy recommends a health cess along the lines of the education cess—and it still won’t be enough, the NITI Aayog has made some good suggestions.
The Aayog has argued that, at a time when the government itself is talking of reducing subsidies, giving free medicines and health care looks anachronistic. More important, it has plumped for more health-insurance driven care of the type popularised recently by the prime minister. Under the new insurance schemes, the number who have got health cover has risen from 21.62 crore in FY14 to 28.87 crore already. Many will argue this is counter-productive since, while it is mainly public sector insurance companies that pick up the tab for health insurance, the costs of insurance-driven health care is shooting up—much better, according to this school, for government to expand its health facilities and go in for universal healthcare access as far as possible. While the government will have to do its best to keep a check on costs in private healthcare and to help keep costs low—experiments with free land for hospitals haven’t worked, but that just means they have to be contracted more smartly—it also needs to be more realistic about comparing costs. Comparing surgery costs across public and private hospitals, for instance, must realistically factor in the subsidies in public hospitals—once this was done for school education, for instance, it became clear private schools were actually more cost-effective. It would also help if various health departments laid out standard protocols for different type of treatments that could be followed by private healthcare facilities across the country. If private provision of most services is cheaper than that by government, there is no reason why healthcare should be so different.