1. Universal healthcare: Here is the way forward for India

Universal healthcare: Here is the way forward for India

India needs to innovate to reduce financial barriers to universal health care

Published: May 11, 2017 4:56 AM
India’s health needs have undergone a dramatic transition in recent years. (Reuters)

Kenneth Thorpe

India’s unprecedented potential for growth is inexplicably marred by one of its more fundamental traits—falling short in ensuring health and social welfare. Despite positive growth indicators and economic progression, the country has lacked relentlessly in catering to the health requirements of the public, empirically validated in its measly budgetary outlays and inefficient execution in expending allocated funds.

A coherent analysis of India’s budgetary policies for health over the past few years paints a dismal picture, with the government persistently prioritising non-developmental factors (such as preservation of country’s defence, law and order, maintenance of the general organs of the government, and so on) over developmental expenditure (items of expenditure designed to promote economic development and social welfare).

India’s health needs have undergone a dramatic transition in recent years. Chronic diseases are now responsible for more than 50% of deaths with a large number occurring at the most productive years of life. The budgetary policies in India have evidently failed to keep pace with the changing disease demographics and healthcare needs.The Social Progress Report 2016-17 scores India 53.92 (out of 100) in the Social Progress Index, ranking at 98, below countries like Cambodia (97), Senegal (96), Botswana (62), Nepal (95) and others. Gaps in public health system play a pivotal role in this regard.

In the face of financial constraints stunting public health, collective effort and innovative thinking is required to pull up India’s healthcare systems.First is effective rationalisation of the limited resources at our disposal for better leverage of health funding. Second, is formulating innovative ways of raising new public and private resources to combat the current limited funding for health; the government needs to look into new financial models for more efficient health care delivery and expanded insurance coverage from the public and private sectors. And finally, it is imperative to enhance the quality and efficiency of health care service delivery to expand the demand and offering of needed services.

India’s public expenditure on health continues to remain one of the lowest in the world, sitting embarrassingly low. According to the WHO World Health Statistics 2015, India spent 1.16% of public expenditure on health as a percentage of GDP, ranking 187 among 194 countries. In fact, India’s per capita public expenditure on health was 55% of Indonesia’s, less than 20% of China’s, and 11% of Mexico’s and South Africa’s. Global evidence on health spending shows that unless a country spends at least 5-6% of its GDP on health and a major part of it is from government expenditure, basic healthcare needs are seldom met. And what is even more disappointing is that public spending on health in India has stagnated over the past two and a half decades, varying from 0.9% to 1.2% of GDP from 1990 to 2015.

Although health has been accorded priority in the 2017 Union Budget, non-communicable diseases (NCDs) have been identified as a priority area, not remaining a back-burner anymore. However, the urgent requirement is to understand the need for an integrated approach to tackle the spread of NCDs. Healthcare financing models need to be developed with public and private collaboration to reduce the burden of expenses of both the government and the public.

Another way to reduce financial barriers to healthcare, is through payment and pooling. As per the UN and WHO the burden of NCDs on India between 2012-2030 would have grown to $6.2 trillion if not tackled properly. For efficient implementation of these pooling mechanisms and for raising sufficient finances the government must put in rigorous efforts, in addition to ensuring proper communication between the centre, the states and stakeholders.
We could even take cue from the successful model of performance-based financing being followed in Rwanda and its neighbouring countries. This can be replicated to the needs and requirements of the health sector in India.
It is also imperative to set up national goals by tracking NCDs and their financial burden, and strategise health policies accordingly. Putting in place proper screening programmes will also help to minimise the burden of NCDs and consequently their cost burden. It is important to facilitate primary health centres with quality services and sufficient manpower to break reliance on tertiary health facilities and provide affordable and accessible healthcare to all.

India cannot rely on a single public healthcare financing system to cover the entire population: it needs to take advantage of the range of insurance offerings—from government central and local, employers and the commercial insurance sector. More reliance on private health insurance can meet the growing demands of the wealthier middle class in India while allowing the government to focus on the poorer, more vulnerable populations. Such a comprehensive and diverse system of health care financing means greater pooling of financial risks, greater sharing of financial risks, and greater satisfaction among the Indian people when their health needs are met.

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