Rising India’s lack of progress towards provision of universal, equitable health care for its people is distressing. The sidelining of the Bhore Committee recommendations of 1946 — which relate to ways and means of building a public-funded allopathic health system for the entire population — indicates the low priority given to public health in policy. The consequence of this disastrous neglect is that Indians have among the highest out-of-pocket expenditures on health anywhere. The Planning Commission is now considering a universal health insurance scheme. The goal is laudable but the premise is wrong. As the workshop of the Kolkata Group chaired by Amartya Sen pointed out in February 2011, influential policymakers seem to think that private health care with proper subsidies or private health insurance subsidised by the state can meet the challenge. This is unlikely to happen because of the asymmetry of information between providers and users, and the absence of patient empowerment. Moreover, costs and quality of care are poorly regulated. If the central government is sincere about building a strong health care system during the 12th Five Year Plan (2012-17), it must accept the primacy of public-funded provision, invest heavily in both preventive and curative spheres, and introduce strong regulation.
The High Level Expert Group on Universal Health Coverage headed by K. Srinath Reddy has the important task of prioritising the initiatives to be taken up during the 12th Plan. Universal health insurance is one stated goal. Here it is relevant to point out that some classes of citizens, such as children, the elderly, and women, can be comprehensively insured first. By focussing on these vulnerable groups, the National Rural Health Mission can take on an expanded role while new urban schemes can be launched to cut out-of-pocket expenditure substantially. There is also a felt need for oversight in the case of private health care providers. In the absence of benchmarking and scrutiny, hospital costs have hit patients hard. It is worth pointing out that the Affordable Care Act enacted last year in the United States emphasises patient rights through special provisions and mandates the spending of 85 per cent of large insurer premiums on actual care to prevent diversion to administrative overheads, salaries, and executive bonuses. Additionally in India, non-profit initiatives in health care can be invited to play a bigger role. Raising public expenditure on health to 2.5 per cent of GDP by the end of the 12th Plan will be a start; it needs to rise progressively. A cess to fund health care can scale up the effort rapidly.