Known for his immense knowledge of the healthcare sector in India and the world, K. Srinath Reddy is a firm believer in the big role that politics plays in implementing robust and all-inclusive Universal Health Coverage (UHC). The former head of the cardiology department of AIIMS says that compared to Western countries, public expenditure on healthcare in India is less and it is high time the governments starts spending more responsibly. During his visit to Hyderabad, Dr. Srinath Reddy interacted with M. SAI GOPAL .
What is the concept of UHC?
UHC has very much been in the public debate since the last five years in India and it’s going to acquire greater visibility again in September when the United Nations adopts sustainable development goals. Among these goals, the number three goal is ‘health’ and out of the several targets, universal health coverage features prominently. Health goal simply means everybody is entitled to a healthy life. One should not confuse universal healthcare with insurance because insurance is one of the several mechanisms for health financing. Actual target under UHC includes financial protection and universal access to affordable drugs and vaccines.
How do you actually provide UHC and where does it fit in India’s National Health Assurance programme?
When you talk about universal health coverage, you are essentially talking about three major health services. This includes covering the entire population, what the depth of medical services provided is and third, the amount of financial protection being provided. This has to be seen not only from the perspective of persons who are receiving medical services but also whether the system can afford a certain level of medical costs.
To cover the entire population, the country and States have to define essential health services under which they will be providing individuals 100 per cent coverage. In the initial stages, services that are not covered in the essential services package may have to be provided free of cost by the government either directly or through purchase mechanisms to the vulnerable section. Financially and socially vulnerable persons have to be provided coverage. But others in the society may have to pay a certain amount for such services.
At present, what is the level of expenditure that governments incur on health services?
Unfortunately, our government spends only about 31 per cent of its public finance on healthcare in the country while the remaining 69 per cent is privately financed. Out of 69 per cent, close to 60 per cent of expenditure is incurred directly from the pocket while the remaining nine per cent is through private insurance and EPFO etc.
In the US, which is an example of complete privatisation of healthcare, even the government spends close to 47 per cent of its finance on public health. In the United Kingdom, health expenditure by the government under National Health Service (NHS) is nearly 84 per cent. In this scenario, we have to look at how best to create a health assurance system not dependent only on insurance because close to 90 per cent of our workers are from the informal sector of employment.
Is there any way prices of medicines can be controlled?
Yes, it is possible. Prices can be controlled but you must have a single buyer like a State or Central government that can negotiate prices with manufacturers. They can procure drugs principally from public manufacturers but also from private drug manufacturers who are willing to participate. Here, the governments can play a very important role. Take, for instance, Tamil Nadu, where the government procures and supplies drugs free of cost through public facilities. Sri Lanka provides Indian-made medicines at lower prices than India provides in its market.
What is the role of the Central and State governments in providing UHC?
The Central government has to create a broad design, a basic framework of universal healthcare, which can be implemented all over India. But within that framework, the States should decide what variation of the essential healthcare package they would be able to implement. They should be able to select the kind of providers to be engaged. States should have the flexibility to choose components of an essential healthcare package.
The bottom line is that no country has delivered proper universal healthcare coverage without a strong public health system. For instance, in Thailand, Mexico or Turkey, we have seen that public health systems (government hospitals) provide strong healthcare services and have managed to keep up standards with less costs. In these countries, the private sector has become a responsible partner supplementing services by filling the gaps at all levels.
