‘There is a high burden on poor families to pay for their healthcare, leading to poverty'

Appreciating the country's commitment towards universalising health coverage for the people, health economist Robert Yates has said the country needs to increase its public spending on health either by health insurance schemes or taxation.

“The entire exercise of constituting a high-level expert group on universal health coverage that India has undertaken has been done at an appropriate time when the economy is growing and the country is getting wealthier as a whole. It now needs to think on how to utilise its resources to provide universal healthcare to its people, and the message is strong and clear that public spending on health has to increase,” he told The Hindu during an interaction.

Dr. Yates is a senior health adviser for the United Kingdom's Department for International Development, where he advises on health financing policy. He will advise the expert group on universal health coverage, constituted by the Planning Commission, on public health financing.

10-year strategy

The Public Health Foundation of India was recently appointed by the Planning Commission as secretariat to the expert group, assigned the task of reviewing the country's past and present health sector performance, and providing a 10-year strategy. The findings will be presented to the Planning Commission at the end of January 2011 as a summary of discussions and recommendations, to achieve provision of healthcare for all. The report will then be used by the Planning Commission, while developing the “Approach Paper” for the 12th Five-Year Plan, in the areas health finance and health insurance.

Pointing out that the country had made tremendous strides in the coverage under the healthcare system, Dr. Yates said there were impressive hospital services, and people were coming to India for treatment. “While it is recognised that India has some highly-qualified health workers, I think the healthcare system is highly dependent on private finances, with people having to pay out of their pocket. In terms of universal health coverage, the system is inequitable and unfair. There is a high burden on poor families to pay for their healthcare, leading to poverty.”

Explaining that this was good neither for the nation's health or the economy, Dr. Yates said the world over, wealthy people cross-subsidised healthcare for the poor, which was more efficient and fair. He said there was high reliance on private healthcare in India, with 78 per cent of people buying services from their own pocket. Public expenditure, which came through taxes, was just about 20 per cent, which was very low when compared to Sri Lanka, and China.

“We can do this pooling of money through explicit health insurance schemes, a large number of which are also present in India — or use tax revenues for the purpose. Raising enough money eventually works like insurance schemes. A large number of countries have protected their people from healthcare expenses in this manner. It can be a combination of the two also,” he explained, adding that these were the issues he would discuss with experts here.

Impressed with the volume and quality of research in India, Dr. Yates believes in wide consultations to get the perspectives of consumers, providers and healthcare professionals, including the public and private sector players. “These issues can be politically sensitive,” he said, citing the example of the United States where healthcare reforms were being led by President Barack Obama himself in the face of strong opposition.

Comparing India's scenario with that of China, Dr. Yates said the Chinese government undertook a similar process some years ago when it realised that its health finance was getting inefficient. It undertook a similar exercise to study the health financing system across the world and ultimately decided last year to put in $125 billion by way of tax financing to improve the coverage and quality and reduce the burden on poor.

“China is now cited as an example of the biggest health reform in the world,” he said adding thathealth sector developments in Mexico, Thailand, and Costa Rica too were noticeable. “The biggest change is taking place in middle-income countries, which are making transition from a very low quality and coverage towards universal coverage.”

Note of caution

Sounding a note of caution that collecting money, pooling it and then getting the maximum value for it would be an issue in India as it was in China, Dr. Yates advocated increasing the proportion of spending on primary healthcare that impacted the poor and the needy, and included basic facilities such as immunisation, institutional deliveries and nutrition. “In India, there is a tendency to spend large amount on tertiary or specialised care that eats up to 50 per cent spending,” he said.

Dr. Yates said it was good that the government was looking at all its existing mechanisms and infrastructure, and building on it. He said even within India, there were good examples of public financing of healthcare, as in Kerala.