India must not overmedicalise its universal health coverage model

Written by Soma Das | Updated: Mar 8 2012, 09:29am hrs
As the country embarks on the road to universal health coverage with the Prime Ministers Office indicating an increase in allocation for healthcare, Soma Das takes up the topic with Mark Britnell, chairman, global health practice, KPMG, and former director general of NHS, UKs publicly funded healthcare systems. Excerpts:

While India is grappling with healthcare at one end of the spectrum to find the right model of service delivery, the US and Europe are struggling at the other end with ensuring sustainability of the models they adopted. Are there lessons to learn from each other

In terms of healthcare, there are more similarities than differences between the experiences of these two distinct blocs, which I believe are not best captured in east-west or north-south nomenclatures, but in a different way. Slowing economic growth, rapidly ageing population and massive healthcare expenditure define the developed economies , and at a macro level they are suffering from pains of old age while the other bloc of emerging economies is characterised by rapidly expanding economies, a burgeoning middle class and less comprehensive healthcare services and can be said to be afflicted by growing pains. There are of course many ways the two blocs can learn from each other. But the first and foremost lesson from the 150 years of economic journey that industrialised countries have gone through demonstrate that wealth creation is inextricably linked to health creation and India would have to provide comprehensive and universal health insurance coverage to its population if it has to grow. On this specific account, India could learn greatly from others experiences.

From the challenges of healthcare models of developed countries, what are the things India must learn not to do

There are three potential traps that India must avoid

while it goes rightly on the path of universal and comprehensive health coverage. It shouldnt have an overly dominant medical model. By that, I mean that healthcare professionals such as nurses and pharmacists can play a significant role in the primary healthcare space.

So, you must be careful not to overmedicalise your healthcare and mistake more number of hospitals, more bricks and mortar to mean more healthcare, even though there is no denying at this point that India does need more hospitals. That is because 90% of all healthcare needs can actually be effectively met by prudent primary care delivery. Secondly, given your expertise in the IT and mobile space, you should radically exploit models to meet healthcare needs. The world is waiting for India to innovate and lead in this space. Thirdly, India must avoid looking at healthcare sector from ideological prisms and adopt a pragmatic approach by letting the public, private-both for profit and not for profit play a role.

In creating a blueprint of universal healthcare coverage, it is the financing of the system that remains the most contentious aspect.

India spends 4.2% of its GDP on healthcare, the lowest among the BRIC countries, while Brazil devotes 9%, and comparable figures for China and Russia are at 4.6% and 5.4%. Indias life expectancy is at 65. You would want your people to live longer and have a more productive life so that it can translate into economic growth. There are five principal sources of health expenditures, which can be tapped. The first is general taxation, the second one is levied through national social insurance, the third one is levied through private medical insurance, the fourth one is through a contribution from the employer and finally a sin tax levied on products such as cigarette or alcohol. It is of course a political debate that decides what a right mix is between the above categories. I believe that in the backdrop of a growing middle class population with a sizeable disposable income, India could use general taxation with increase in state spending and private medical insurance to strike a balance for funding.

From the emerging economies that are perfecting their healthcare models today, can we borrow and adapt some frameworks

From my experience in countries which are in the process of developing comprehensive healthcare systems, the government here must have an absolute clarity of vision, an absolute transparency of processes about how you are going to build and run the system. Besides, there should be a high degree of trust between the public and private sector. These are the three cornerstones for a successful and efficient healthcare model.

Are there any inspiring islands of excellence in the Indian healthcare space, especially in private sector which have captured your imagination

One example is Aravind Eyecare, which uses mass standardisation process to create value in healthcare, with absolute focus on service, minimised cost and maximised quality of outcome. We are watching with keen interest how Fortis Healthcares vision of low-cost, high-quality healthcare delivery model is shaping up. And generally speaking, what strikes you most about India today is a palpable sense of optimism and emotional energy that contrasts sharply with the tough time that the US and Europe is going through. We wish we could sprinkle some of it across the world.