Towards Universal Health Care in India
Quality health care for all Indians calls for creating social conditions that are conducive to good health across the life cycle as well as universal access to quality assured health services. Vulnerable sections of the population, such as, the poor, tribal and socially disadvantaged groups need special attention in a program of universal health care. A fundamental framework to providing universal health care must be founded on the principle of right to health, a principle that is aligned to other rights based approaches that are vital to democratic societies.
Almost two-thirds of all health spending in the country is out-of-pocket. It is estimated that expenditure incurred on health has resulted in 7% of the population falling into poverty. A large proportion of catastrophic health expenditure falls on the poor and is spent on outpatient care and medicines.
In this context, there is a need to establish a people-centric system of universal health care which is based on the strong foundations of primary health care and positions a strong public health service as the main vehicle of service delivery.
The thrust must be on public provisioning for health services and infrastructure, rather than the current trend of introduction of insurance based models where the government pays for the premiums while health care provisioning is left to the private sector, with the investments in public provision declining over time. There are a number of problems with the insurance based model, including- health care continues to be inaccessible in remote areas, outpatient care is not included (where most spending takes places), public systems are weakened, there is the danger of supplier-induced demand (especially with the private sector involved), and healthcare becomes more expensive. Further, when these benefits are targeted inclusion and exclusion errors arise.
7.1 Accelerate government expenditure on health care gradually over a period of five years to a minimum of 3% of GDP, where three-fourths of additional increase to be set aside by the central government. These additional resources must be allocated to strengthen government health system at all levels, with primacy being accorded to primary, preventive and promotive care. Atleast 65-70% of additional resources must be devoted to primary health care, by improving health infrastructure, providing the necessary health workforce, medical supplies and strengthening the governance framework.
7.2 A transparent and accountable pooled procurement of generic medicines and supplies need to be established in every state and at the centre, alongside doubling of public spending on medicines and supplies over and above the current expenditure to the tune of Rs. 15,000 crore annually.
7.3 Regulation of private health system is extremely urgent given its uneven growth. Strengthening Clinical Establishment Act and enforcing it assumes supremacy with certain tasks to be taken up on a priority basis, such as, listing of prices for medical procedures, regular sharing of epidemiological data with public health authorities, etc.
7.4 Communities, local governments and civil society organisations must play a critical role in facilitating convergence of programs and schemes across sectors, with social audit as the centrepiece. Health councils and health assemblies must be set up at all levels of government.
7.5 A public health cadre would be the focal point in delivering primary care while secondary and tertiary curative care would be tasked with medical specialists. The current practice of recruiting temporary/contract staff/workers must be eschewed while a regular supply of medical and non-medical staff is required for strengthening government health system.
7.6 Trained nurses, allied health professionals, health workers to play central role in delivering primary care. Two ASHAs replacing current level of one ASHAs to be central to this strategy while at the same time they will need to be paid salaries and other compensations at par with any other government staff.
7.7 Regulation of medical colleges to curb commercialisation by abolition of capitation fees, reducing tuition fees, bringing in standards in private education.