The High Level Expert Group of the Planning Commission on Universal Health Coverage for India has laid out a clear road map: it is to provide access to affordable, accountable, and appropriate health services for all citizens in a meaningful time frame. Free India adopted the goal of preventive and curative care for all, as recommended by the Bhore Committee in 1946. But it faltered and failed to raise public spending. What the expert group chaired by Dr. K. Srinath Reddy proposes is far-going reform in several areas. On funding, it puts the onus on the government to mobilise the resources necessary, relying mainly on general taxation; complementary funds would come in the form of mandatory deductions for health care from salaried individuals and tax payers. Country-level policies oriented towards equity and free, universal access to health care favour such a financial model. This is also logical, considering that health should be viewed as a public and merit good available to the entire population. India's approach to public spending on health needs a radical change. It has a pathetic record of devoting a mere 1.2 per cent of GDP as public expenditure. To scale up care, that must be raised to at least 2.5 per cent by the end of the 12th Plan, and 3 per cent in the subsequent five years. This, the expert group estimates, can bring about a dramatic reduction in out-of-pocket spending from 67 per cent of total health expenditures today to 47 per cent by 2017 and 33 per cent by 2022.
An entitlement to free health care, implemented through a carefully chosen package of cashless in-patient and out-patient services, will be a paradigm shift. This is doable, given consistent GDP growth. Moreover, there is adequate room in the tax system to accommodate new demand for a national health plan; after all, India's tax ratio, at a little over 15 per cent of GDP, is much lower than the average of 22 per cent for countries with comparable per capita incomes. The private sector can participate in the provision of universal health coverage as contractual partners, with appropriate regulation and monitoring of costs and quality. The key principle laid down by the expert group for universal access is to not levy any user charge at all. Levying such fees can perpetuate or widen inequalities in poor and middle income settings. The more rewarding approach would be to invest heavily in the public system to provide primary, secondary, and tertiary care, and use private expertise mainly to strengthen that capability. The recommendations of the expert group, including the emphasis on making essential medicines available free to patients through state funding, must be wholeheartedly welcomed.
Comments:
A sensible health policy is the need of the hour. Government hospitals must be strengthened by the provision of sophisticated equipment and duty conscious doctors.The private sector need not be made richer as in the case of Arogya sri scheme.It must be compelled to part with 25 percent of its profits to safeguard the interests of the public as part of corporate responsibility. The public expenditure on health must rise to five percent from the present pathetic 1.2 percent of the GDP.
It is indeed a welcome set of recommendations, however, the editorial is missing one critical point. Rural India is suffering from dearth of doctors who for the reason of less incentives are more prone to end up in urban areas which pay them much higher. I haven't read all the recommendations of this committee yet, but i believe it would have thrown some light on this vexatious issue of doctors not wanting to serve in rural areas leading to exploitation by middle-men, fake doctors and private medicares.
This is the time to realise the real situation of Health Sector in India as so many children in northern States died due to lack of infrastructure and human power. The Health Expenditure increase in the 12th Plan is a inviting move to reduce the medical expenses of the public from their pocket instead the Health Insurance scheme has to be competitive, permit so many companies and based on their service and hospitals the linked the public can choose their own.
Government should work on appointment of Govt. doctors to rural areas specially. Mostly well served private hospitals are in cities and less patients go to govt. hospitals of cities and doctors in these hospitals not perform their duty honestly while in rural unskilled people opened hospitals for their income only and serve costly and poor service to poor rural patients. it will really change the picture of rural health care system when the hospitals of rural areas will get doctors in it.
The contour of the health services also will be quite important - a comprehensive health services package should have considerable accent on prevention and focus on the socio-economic determinants of health. Otherwise it will be like UPA's inflationary and growth-without-employment policies and doling out cash for as short term social assistance. What is required is an integrated public health policy. In terms of funding, one should be really weary of PPP because most Indian corporates have an uuimpressive background. Instead the model to pursue may be the private sector contributing resources on a regular basis (the way they do to NGOs) and even taking donations from individuals. If wikileaks can generate money through contributions, why can't public institutions?
This is a much needed positive step in the Health sector.But for this scheme to bear fruit, there is a need of development in existing infrastructure of health sector. In US it is successful because almost 80% of the hospitals are privately owned. So they can provide better facilities. But in India,the health sector is still in growing stage and private partnership is still in infancy stage.Hence before implementing this scheme,govt should also look at its outcome.
health care in india is in a dismal state, gdp ratio for the health sector is also quite low even when we compare it other developing countries, keeping this thing into regards increasing the gdp ratio for the health sector is the appreciating step but this only not help to improve the health conditions in the country, strict delivery mechanism for providing health services to the poorest of the poor should be the target of the policy maker and for this public intervention is required at every stage as we cant rely on the private sector for the health services for poor and in rural areas, by this only our state can improve the health condition in india.
The proposal of increasing spending in health care has been implemented many times,but the effect seems to be very less. The penchant for getting all things "free" doesnt work. Probably there is nothing called free lunch. The most projects for improving health infrastucture gets mired in controversies - buying unnecessary equipments, spending highly for meetings for discussing how to improve health care, taking drugs in bulk without considering its demand ( as in case of tamiflu).In paper all health policies look so beautiful but at the implementation stage it falters. There should be greater control on drug price and quality as well as monitoring of private institutions effectively.
The health sector in India is in a pathetic condition.The private sector is doing slightly better than government sector because of competition.In the govt. set up if less number os patients come to a hospital it's good for the employees as they will get less work.I couldn't really see any meaningful way of improving the public services in India,until some draconian law stating that medicos will be charged against manslaughter case for every single deliberate failure form their part.Since I qualified nearly 2 decades ago, I couldn't see any meaningful improvement in the public health service.It's the right time to think whether we should waste more money in the govt. sector. Universal Insurance scheme, close monitoring of the private hospitals for their care by independant commission just to name and shame the hosptial(but no legal power as it will lead to corruption)and better role of medical council in regulating the professionals is the way forward.Other thing will be a waste.
The issues with the medical field in India is multi faceted. Uncontrolled population growth, poor governance and monitoring of medical institutions, lack of accountability and ignorance of patient rights. It is no easy job fixing these issues and cannot be done over night. India has to come up with a system that will work well for her situation and not emulate the West. For example Cuba has one of the best medical systems in the world that was tailored to her situation. The infant mortality in India is ten times higher compared to that of Cuba. I do not think, the medical needs can be full filled by increasing the number of medical seats and mass production of doctors. This will lead to degradation of medical standards. One thing India consider is supporting mid level health care providers like medical assistants or physician assistants who do not need the same educational training as doctors. They can be mass produced in a short time. They can be monitored by existing doctors.
Without investing in education & ensuring EDUCATION to all citizens (making all to understand basic hygiene & healthy nutrition), Making many hospitals n distributing crores of pharmaceutical drugs will not work.
After working in govt. Hospital, i realised, after giving correct drug n explaining right doses, People are not following it. Poorly educated people don't understand basic things. So, Plz invest education more.