An increase in public expenditure on health from an estimated 1.4 per cent of GDP to 2.5 per cent by the end of the Twelfth Plan can, if it is used wisely, bring about a revolution in health care. Prime Minister Manmohan Singh's resolve to boost government spending can potentially make high quality care accessible to all. Universal health coverage, including cashless treatment, is to be achieved through greater expenditure and a system of strong regulatory oversight outlined by the Planning Commission's High Level Expert Group (HLEG). Arguably, with a significant increase in public funding, India can move towards its own model of Britain's famed National Health Service. There is some scepticism about the country's ability to shift to a good tax-funded plan for universal health coverage, but as the HLEG points out, the trajectory of economic growth makes this the opportune moment. Apprehensions raised by special interests against health reform are, naturally, self-serving and should not cloud the vision. What should be borne in mind is that the HLEG has not suggested the scrapping of the private health sector but its participation in the UHC plan on a contracted-in basis, with tight monitoring of costs and protocols.
The need for publicly-funded universal health coverage is beyond argument. At present, private out-of-pocket health expenditure constitutes 3.3 per cent of GDP, or around 67 per cent of the total spending. Moving towards universalisation of care can cut it to about 33 per cent by 2022. Clearly, a policy approach that relies primarily on for-profit health insurance and services cannot provide universal cover, as the experience in the United States has demonstrated. The key to universalisation lies in including everyone in the risk pool, through a system of means-tested compulsion and taxation. Making such a plan work requires extensive reform of standards, protocols and oversight bodies for both public and private sectors. Here, the HLEG has provided a road map that envisages setting up of public health cadres for services and management at the national and state levels, standard setting, and a timeline for merger of existing government-led health insurance schemes such as the Rashtriya Swasthya Bima Yojana and those operating at the State level. An increase in outlay on medicines from 0.1 per cent of GDP to 0.5 per cent for public procurement can ensure free universal access to essential drugs. This measure, suggested for implementation through contracted private chemists, among others, is also vital to cut out-of-pocket expenditure. The States, which are increasingly looking towards private health insurance to fund health care for the poor, should find the HLEG recommendations more sound.
Keywords: government health care, healthcare policy, Twelfth Plan, Planning Commission, India public expenditure, universal health coverage, health expenditure, government health scheme, health insurance sheme
i feel people should be educated regarding basic things like cleanliness.i know it is very difficult to educate each and every individual.still cleanliness,awareness regarding food,nutrition,diseases can reach people thru' multi media.few things should be made mandatory.for eg.,documentaries in T.V/FM/MOVIES should be must.next comes the local health care centres where compulsory awareness programes by nurses,doctors to local people.self awareness may reduce morbidity and improve health.training people in health services,allocating sufficient funds right from primary health care level should be done.health care system if improved from primary to higher levels will surely increase better quality of life and disease free life to some extent
this move deserves applaud.We are boasting of good GDP growth rates but
we are one among the poorest in heath indicators be it infant mortality
rate, malnutritioned childrens,mortality rates during pregnancy and so
on.So in such a poor conditions,we really require investment in health
sector provided it really reaches to beneficiaries efficiently.
Just to make a point - I think these figures are wildly optimistic for overall cost. Although india has economies of scale to its advantage - be wary of what happened in britain after universal health care was set up. The budget was wildly in excess of the best estimate at the time bacause more people came forward with ailments which had been ignored for years than anyone could have guessed. On top of this, health expenditure begets health expenditure as people live longer, and more often suffer from complicated ailments of old age such as cancer. Health explenditure has never gone down in real terms in the UK since 1948. Not that I am in any way opposed to this as an idea - it is the best move india could make economically and morally. A healthy workforce happier and more productive. It is just better to be prepared and budget for proper rather than peicemeal 'universal' healthcare coverage.
Inclusive & comprehensive healthcare can only be provided if the govt. succeeded in fulfilling the basic needs of the people. If there is adequate food intake, nutritional security, have access to clean drinking water & better sanitation facilities. Much of the attention needs to be drawn towards the preventive aspect of the healthcare rather than the curative one. Use of indigenous resources for providing health education, full community participation, motivated public health workers are some of the key elements for by which we can assure universal healthcare.
Really it is a wise step and also good sign for Indian health (wealth also)but there is always lacuna behind policy and execution. Hopefully we common people wait for best.
Fantastic idea, great move towards improving public health &
sanitation. Prevailing conditions in public-healthcare facilities and
factors like immigrating doctors & commercialization of health-care
only indicates the predicaments of a normal citizen. Access to trust-
worthy hospitals has become either a matter of luxury or facing long
night-mare like queues.
I personally believes this sector has long awaited for the much needed
attention and fund. Increasing the fund allocation almost to the twice
should definitely bring relief.
However it will be wise for planning commission's HLEG to retrospect
and analyse the statistics for what component 1.4% expenditure ended
up as real output, and what measure will HLEG take to make sure
whether this increase in healthcare expenditure is directed really
towards implementation and not in stashing personal accounts of
bureaucracy? Failing to do so will render this as only another
statistical figure to be flaunted by politicians and news reader.
I agree with Vyasjis points. I want to add something,When we think of public health coverage we must think of indigenous treatments rather than applying a totally western aproach.
How the proposals get translated into action is for all of us to wait and see. Increase in health allocation to 2.5 of GDP is indeed welcome. The mediclaim scheme which is in vogue in a few sector, partly contributory, offers health care only to a microscopic minority, say less than 0.3%of the workforce. The private medical Institutions usually share the bigger slice of the cake. The scent of commrcialisation is there for all to smell. Think of the plight of the crores who seek shelter in the state run hospitals, where the patients are driven from pillar to post for usual drugs, and for better management, let alone the pitiable hygene in its corridors. The time bound surgeries to save lives of patients are put on hold mostly for want of gadgets and resources in govt.hospitals.Any paise,allocated worthfully by the centre for a better health care tp the poor is a step in the right direction.
Universalisation of healthcare services is one of the most desired reform in India. A healthy population is more productive. It will also lead to less burden on lower income group to save money for healthcare, which may encourage them to spend on other areas such as education.
A very important point to note here is that of hygiene and proper drainage facilities which are lacking in many places and gives rise to unhealthy conditions.Provided better facilities and proper infrastructure, the task of spreading awareness among population would be a big challenge but something which can be addressed.Sharing of responsibility by the citizens is very much the necessary to achieve such goals.
The Increase proposed by the Govt. is nothing compared to need of the
people. With an inflation at galloping speed(forget the F.ms data)and the higher cost of medicine,salaries,overheads etc will make this cosmetic increase insufficient.
The P.M had the AUDACITY to state that 65% of India's children are UNDER NOURISHED. He has conveniently forgotten that he has been at
helm of affairs for the last 7-8 years as P.M heading a party which was in power over 50 years since 1947. What have these ruling elite did for the ordinary people.
Mahatma said that the Govt should think how every act of theirs affect the poorest of the poor. This Govt.is acting only to see how the Rich and Powerful can be helped to reap more. 50% of the "Rebates" given to the Rich on Tax could Cover World Standard
Health Care for all in India.
Even the Well Respected Media SHY AWAY ON THIS TOPIC.
This piece may not pass the Moderators
A recent article in EPW (XLVII No.4 28.1.2012 by Sunil Nandraj
referred to most states not implementing the appropriate health
regulations adequately and not discharging accountability.. The recent
accidents and series of infant deaths soon after delivery have still
not bestirred the nation to revamp its health services. It may satisfy
economists and planners to find increased percentage of expenditure to
GDP on health but people want effective delivery of services. Shameful
and shocking is this one incident in a district hospital in MP. A
woman delivered her baby even as she entered the hospital waiting for
the hospital staff found to her mortification her new born child being
dragged by pigs who roamed the hospital compound and feasting on the
new born. It was only an alert farmer who happened to be at the scene
who drove away the pig. Two years back London’s DT disdainfully
pointed out to our slick flyovers and state of the hospitals i
Actually what is required is political will. Opening district hospitals to education, making them teaching hospitals will be a good, plus inexpensive, first step.
Health care require utmost attention of government. India can only
progress when its people are healthy and strong. For this inclusive
model of healthcare system is needed, in which everyone have equal
access to healthcare facilities. Cashless healthcare facility will help
in achieving universal healthcare.
This is a very important step for a populous country like India and Editor's suggestions must be well pondered by the responsible people in government. What are we doing all these days? Skeleton services for all our problems! One of the Primary and basic things India has to do at once in this program is to make India Trash-free similar to west. Cleaning roads, rail tracks, rivers, surrounding environment by toning up municipal workers and warning general public on dos and donts. This improves menace from mosquitoes, flies and hazardous bad odour. Let us make it a Trash-free Healthy India Mission.
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