The report of the parliamentary Standing Committee on Home Affairs calling for a comprehensive Public Health Act , as a response to the extreme stresses caused by COVID-19 , is a welcome call to reform a fragmented health system. When the pandemic arrived, National Health Profile 2019 data showed that there were an estimated 0.55 government hospital beds for 1,000 people. Prolonged underinvestment in public health infrastructure thus left millions seeking help from a highly commercialised private sector with little regulatory oversight; the situation was even worse in rural areas, where care facilities are weaker, and urban workers fled to their villages, afraid of the cost of falling sick in cities. Acknowledging these distortions, and the inadequacy of existing legal frameworks, the panel has called for an omnibus law that will curb profiteering during such crises and provide robust cashless health insurance. Its indictment of the feverish commerce surrounding health-care provision, however, can serve a larger purpose if it covers overall system reform, addressing the structural asymmetry created by misguided policies. India has committed itself to covenants such as the Sustainable Development Goals, but continues to evade making the right to health a full legal and justiciable right under the National Health Policy.
Among the committee’s observations is the absence of insurance cover for many and oversight on hospitals to ensure that patients are not turned away in a crisis such as COVID-19. While the panel is right to view this as a breach of trust, one of the pandemic’s impacts has been a staggering rise in premiums, especially for senior citizens, of even up to 25% of the insured value. What is more, the insurance regulator, IRDAI, set 65 as the maximum age of entry for a standard policy earlier this year, affecting older uninsured citizens. Such age limits must be fully removed. The answer to creating an equitable framework lies in a tax-funded system, with the government being the single and sole payer to care providers. This is a long-pending recommendation from the erstwhile Planning Commission, and should be part of any reform. The government, as the single-payer if not sole care provider at present, would be better able to resist commercial pressures in determining costs. This is equally applicable for central procurement of essential drugs, which can then be distributed free. Legal reform must provide for a time-bound transition to universal state-provided health services under a rights-based, non-exclusionary framework, with States implementing it. Private arrangements can be an option. COVID-19 has exposed the dangers of excessive reliance on private tertiary care. The corrective lies in raising public spending to the promised 2.5% of GDP on public facilities that are universally accessible.