Brazil, Mexico and Thailand have done it. Many countries with a sound understanding of development look at Universal Health Coverage as a vital requirement to achieve it. India is at a crossroads. Introducing UHC in the 12th Plan can transform the lives of Indians, create new jobs and galvanise the economy.
Most people would agree that one’s income or caste or gender should not bar one’s ability to get decent quality health care when one falls ill. A poor person should not have to borrow heavily, sell off her meagre assets, or decide not to get treated at all because she can’t afford the cost of care. Unfortunately, this is exactly what happens to many people today. Far too many households fall below the poverty line trying to cope with the high cost of health care. Even for middle class families, the rising cost of staying healthy can put a serious strain on the budget. The health care system is seriously broken despite the existence over many decades of primary, secondary and tertiary health centres and public hospitals open to all. And despite the rapid growth of high end corporate hospitals that get free public land and other subsidies in return for the (often broken) promise of reserving a share of beds for poor people.
Click here for The ABC of UHC (pdf)
Ensuring universal health care is a major concern of governments the world over. The rapid growth of high end technologies for diagnosis and treatment, and the fact that people are living longer and are more likely to need health support when they age, has become a challenge even in countries like the U.K., long known for its ability to guarantee decent and affordable care through a National Health Service. Here in India, however, technology and aging are not yet the main problems. Consistent public underinvestment in health — barely above 1% of GDP — is a major reason why health care is so unaffordable for so many people. This puts us near the bottom of all countries for this measure. Around 70% of total health spending is out of pocket, and around 70% of that is on drugs. Poor people go less and less to public facilities to which they would go earlier because they almost never have the free drugs they are supposed to provide. This is a great irony for a country that has gained respect in Africa for making drugs affordable through our export of generics to them.
Generic drugs
An important low hanging fruit identified by the High Level Expert Group (HLEG) on Universal Health Coverage (UHC) set up by the Planning Commission is to provide generic drugs through the public system. The HLEG also recommended in its report submitted in October 2011 that health care should be available to all citizens with a smart card and should be cashless at the point of service. An UHC system should provide a combination of preventive, promotive, curative and rehabilitative care through a package of primary, secondary and tertiary services. An emphasis on prevention and promotion at the primary level would be both cost effective and best in terms of health outcomes.
Higher public spending
The HLEG called for stepping up public investment in health to reach 2.5% of GDP by the end of the 12 Five Year Plan, and argued that a strengthened public sector must be the bedrock of reforms. But how to deal with the fact that public facilities themselves ignore public health, often lack adequate staff and equipment, and treat patients with scant respect? More investment must be backed up by the creation of a public health cadre, the recognition of a three year medical qualification in order to increase the availability of qualified professionals, and more staff at the lowest level. And a strong set of management reforms to improve quality and performance of public facilities must be urgently implemented.
The HLEG’s support for public investment in health is backed by the experience of many countries — Europe, Canada, Brazil, Thailand, Mexico, to name a few. But one cannot ignore the reality of the private health sector or the fact that it can and ought to be made to play its part in the move towards universal health coverage. At present, private facilities, under a veneer of respectful treatment, can be hugely expensive, and often do not provide appropriate or high quality clinical services. Ensuring that private health providers play a responsible role requires that we move away from ad hoc and unregulated public-private partnerships (PPPs) and also away from the practice of giving subsidies and freebies like land and tax-breaks to the private sector without any effective mechanisms to ensure accountability. An important recommendation of the HLEG is to set up independent and effective Health Regulatory and Development Authorities at both national and state levels that would supervise the quality of services delivered by both public and private sector providers. These bodies would ensure among other things that standard treatment guidelines form the basis of clinical care across both sectors, with adequate monitoring to improve the quality of care and control costs. They would also ensure grievance redress mechanisms by linking up with measures to ensure citizen participation and accountability. This has been done very effectively in countries that are at the forefront of the move towards universal health care such as Thailand and Brazil, and must be implemented in India.
(Gita Sen is Professor at the Centre for Public Policy, Indian Institute of Management, Bangalore)
Sonia gandhi can spend several crores on her health by traveling abroad
and we Indians have to wait for 10 years to get UHC.
The basic problem is overpopulation because of unlimited procreation.
The how can one expect
Govt can provide optimal coverage for every one,unless every citizen
thinks to contain population?
I agree neither with Satendra nor with Gita Sen; the latter has raised important
questions though. We need a paradigm shift. The poor got free treatment in
government hospitals from colonial times. The General Hospital in Chennai and the
Madras Medical College are not something to be mocked at. Their public service was
commendable, the doctors were experts, almost every one got free treatment and
VIPs came there for medical treatment. Allowing private practice by the doctors
brought that edifice down. They were and are behind the corporate high-flyers. Still, I
have seen islands of public service in government hospitals. GOI should revitalize the
corrupted Medical Council, upgrade the government hospitals, enforce discipline and
punish erring corporates, nursing homes etc. This does not cost much money. Public
will cooperate in enlightened self-interest. Corporate health insurance is a failure in
India. Look to the UK and not USA for guidance. Medicare is no patch on NHS.
Our country, sharing 1/6th of the world's population,lacks
significantly in trasforming this into a resource.two components
namely education and health are the real drivers of this
transformation besides others. GOI has taken significant steps in this
directions, it guaranteed 'right to education' to universalize basic
education but fully implimenting this in its real sense is a
challenge.on the other hand 'health is wealth' ensuring minimum
physical as well as mental strength is absolute necessary for
development of any human kind. to achieve this end UHC is pre
requisite.
"If wishes were horses, beggars would ride."
There is no mention of Cuba's national health care system - praised
by UN and BBC as one of the best public service health care models.
Cuba's system certainly has flaws, but should be something that
India should take keen note of.
Our Government should think the models adopted in thailand or Brazil and
bring legislation immediately. Why the Government is waiting on these
important issues Our parliamentarians should think and act with a sense
of responsibility. Universal health care is a must for any Democratic
country.What is the use of telling india the largest democracy in the
world. Even State Government, Tamilnadu with the active CM can do
something immediatly.
I live in Brazil for the past 30 years, the problem of public health service encountering here is similar to the situation of India, slightly better if I would say. If you have health insurance your are safe otherwise you´re finished. Public health scheme is an Electoral theme but in reality situation is different after election. Giving and forgetting promise is the game politicians played us, and they continue to do so. If one sees the level of corruption, one gets real sick. It may appear folkloric to say this: Why not government confiscate all those millions and channelize for public health investment through judiciary means.
If the govt scrapped all the useless trash that goes under the generic name of "alternative medicine", it will be able to TREBLE or QUADRUPLE investment and other spending on REAL health care.
Universal Health care is the need of the hour.
India needs a. clean water supply to all (this would reduce 80% of illnesses in India,
that are water borne) b. uninterrupted electricity to all homes c. read and write literacy
for all its population, d. right information source from an independent news
corporation 'similar to BBC'.
Universal Health care, would enhance health, productivity and security of the entire
nation.
It is a great development and India can easily achieve it.
Our current situation is a shame. Nothing short of overhauling of health system is required. When Thailand can do it why can't we ? Pure lack of political will.
As a physician after reading this piece I can only feel pity for these people who sit in high offices and spout so called policy statements without the foresight to see what damage this would wreck in the near future. Regulatory authorities in India are an euphemism for corruption and neopotism and they are never an answer. The answer lies in increasing the awareness of the people regarding their own health so that they start looking at healthcare as their own responsibility and right. After all only way we can ensure equal health care for all is to ensure that all are aware of their rights and doctors in the public sectors dont think they can behave as gods as they are doing their duty to a patient.
Geeta sen is probably is not a doctor and did not think deep while writing this article or have no capabilities to understand medical problem. despite of having inadequate half baked courses why not give permission for medical colleges. clear all files and give permission to all person/groups to start medical collages. this will attract better students than half baked medical courses and better health care. do any one have the guts?
According to the WHO's WHR 2006, it is indeed minimum 23 health workers
per 10,000 population to deliver primary health care interventions
prioritized by MDGs.
The JLI Report "Human Resources for Health: Overcoming the crisis",
published in 2004, had suggested a threshold of 2.5 health workers per
1,000 population, i.e. 25 health workers per 10,000 population, and not
23...as written in your piece here. you have not mentioned any source
for the data used in your piece!
Hospital Charges are as good as or as high as School and College fees
and are moving up very fast more than the inflation rate.
Even for an upper middle class family,it should be prepared to spend at least about Rs.5 lakhs for a Bypass surgery,which amount would not
be readily available out of savings. They have to necessarily borrow
or sell some of the financial assets and meet the expenses.
Even if they have a mediclaim Policy, experience of some of my friends
indicate that, at least 50% of the bill will have to be met out of own
sources.
At the current inflation rate of about 8-10%, the bills are likely to
double every 5-7 years.
Something has to be done at the Stakeholders level to optimise the
expenses which can be easily met by an individual.
very well explained.......
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