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Is India Heading for a Universal Healthcare? While the story of Indian health care is one of excellent policy, it is also one of poor implementation

By Dr. Vispi Jokhi

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Working on the premise of the current healthcare system in India, there are questions that bring forth the answers to what does the industry need, to be at par with the global counterparts.

  • Can the Indian state provide basic and advanced health care universally as a basic fundamental right?

  • Can provision for health care be seen in isolation, separate from basic needs of food, water, sanitation, clean air and noise free environment?

  • Should the focus be on preventive and basic health care or on modern high technology healthcare solutions?

  • Can we ensure that out of pocket expenses are minimized and catastrophic illness does not push families to reach below poverty lines?

  • Can the medical and nursing provide the human resource needed to provide healthcare to our population which is free and accessible to every citizen?

While the story of Indian health care is one of excellent policy, it is also one of poor implementation. As early as pre-independence era the Bhore Committee created a policy of intended Universal Health Cover accessible to all at no cost provided in an equitable accessible delivery system without any discrimination. This was to be done by a network of Primary Health Center, Referral Hospital, District Hospital and Metro public hospitals. This was great on paper, but the non-allocation of adequate resources in face of burgeoning population led to a complete breakdown of this system; leading to growth and prosperity of the private health care system, especially in the cities and the second and third tier metro towns.

This led to marginalized and financially weak, who could not afford this care, seek the counsel of quacks and alternative medical practitioners who provided poor quality health care. The gap has been bridged to some extent by charitable and missionary hospitals, but even they have been burdened by the government with unreasonable expectations. The poorly regulated pharmaceutical industry along with medical device and implant industry has added to the common man's burden and created a hardship. The out of pocket health care expenditure in case of major illness in more than 60per cent of households is considered catastrophic health expenditure and is more than 40-50per cent of the household income.

What Has Been the State's Answers to the Above issues?

  • It has been a sad story of criminal neglect and wrong policy. Instead of strengthening the health sector India spends about 1per cent off its GDP on health care which ranks lower than most countries who provide universal health coverage which India aspires to provide to its citizens. Over 70per cent of health care spending is out of pocket spending by individuals. The Government needs to strengthen the public sector by providing at least 2.5per cent of the GDP for health care expenditure.

  • Indigenous and alternative medicine branches have been legitimized as providers of health care through a policy of allowing them to practice allopathic medicine by providing a bridge course. This is dangerous and an unacceptable compromise on quality. The policy of unregulated or poorly regulated private medical colleges has led to a deterioration in medical education leading to a human resource crunch. The quality of training and education should be standardized to ensure well-trained medical graduates. Another factor should be to increase the number of medical training centres without compromising on quality.

  • Development of the country is not geographically uniform, leading to migrants from poor rural to live in slums and shanties in the city. Facilities for proper sanitation is needed to improve the quality of life of this citizen in order to provide better health.

  • The government's policy of purchasing health care through a mechanism of the state provides insurance is a good policy on paper, but unrealistic rates have created a situation where malpractice and poor quality leads to hardship for the patients. These rates should be revised so that the proper care is given and private health players are benefitted without profiteering at the expense of the poor

  • Generic drugs, medicines with the same chemical composition as the original drug, is a great way to ensure the provision of medicines across the country and at varying costs to suit all segments of society. However, it is failing on account of unavailability of medicines and questionable quality.

  • Another is of focus should be mental health, as it has a direct bearing on physical health too.

In conclusion, the state needs to strengthen the public sector and relook at its policy of purchasing health care and adopt realistic pricing. Also, the benchmarking of income for the indigent section for availing medical discounts defined by the present criteria is unrealistic, and hence cases of misuse tend to be high. The use of insurance with reasonable fair pricing can allow India to provide universal health care in the short run. Sustained spending on the health care system to strengthen it will ultimately be the answer to India's health care problems
Dr. Vispi Jokhi

Medical Director, Masina Hospital

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