Increasing public financing for health care, allotting 70 per cent of funds for primary health care and regulating drug prices are the key factors that would go towards providing universal health coverage in India, K. Srinath Reddy, president, Public Health Foundation of India has said.
Tax funds must be the principal source of health funding, with insurance and employer contributions being minor funding sources, Prof. Reddy said. While India's per capita health spend is about $100, the public contribution is only about $19. Much of it is out of pocket expenditure for the patient, he said delivering the 2011 Guhan Memorial Lecture, organised by the Citizen consumer and civic Action Group (CAG).
Unfortunately, in India, health care is a great cause of impoverishment and exacerbation of poverty. India is a country in which 39 million people are pushed into poverty every year because of health care costs. Several more are teetering on the brink, Prof. Reddy stated. Clearly, it is imperative to look at a health care system that is more efficient, effective and equitable.
Public health spending has remained stagnant at about one percent of the GDP, but since the GDP has increased, more funds than before are now available for health spending. However this has not translated into better health care facilities, as most of the money has been plunged into tertiary care, instead of primary care, and state-led insurance schemes that are focused only on tertiary care.
For instance, in Andhra Pradesh, about 55 per cent of the health budget goes to tertiary care; and in Delhi and Tamil Nadu, it is crossing 50 per cent. “If we do not articulate at this point in the rational need for a universal health care system now, many States will follow suit and start developing these insurance programmes which will be difficult to withdraw later.”
The need to regulate drugs is pivotal to achieving universal health care, Prof. Reddy stressed. Medicines account for 72 per cent of health care costs, so these costs need to be pegged down. Also with data exclusivity being inscribed into some of the free trade agreements in Europe, the Indian pharma industry and its ability to provide low-cost generic drugs will be crippled, he added.
However, quick wins in reducing health costs can be achieved by replicating the institution of Tamil Nadu Medical Services Corporation (TNMSC) throughout the country. TNMSC has an excellent system for procurement and distribution of drugs. Prof. Reddy also suggested providing price controls right from the wholesale pharmacist to the retailer and that a network of public pharmacies be built up across the country. Universal health care has been the subject of the WHO's report of 2010, Prof. Reddy said. Many of the countries in the world have taken up universal health care as a policy imperative and India must wake up to this reality, he said.
State-driven system stressed
M.K. Mani, chief nephrologist, Apollo Hospitals, recommended a nationalised system of medicine where every doctor would work for the government. All medical care would come then from the State, instead of the present system of two distinct set of institutions in the private and health care domains.
He stressed the need to focus on prevention and means of keeping the costs of treatment low. The Kidney Help Trust was seeking to prevent kidney disease in a group of people by providing for early detection of diabetes and hypertension. This had led to reduction in the incidence of chronic kidney disease from 28 per 1000 to 11 per 1000 population.
N.L. Rajah, and Arjun Rajagopalan, trustees, CAG, also spoke.
