- Sep 19, 2016
In an earlier article on five strategies to wake up the moribund Indian public healthcare system, the first strategy recommended by yours truly was to “declare health as a fundamental right and to provide universal healthcare”. Excerpt:
First Strategic Intervention – Comments And Suggestion Of The Author: India is today a $2.3 trillion economy and growing, it is the right time for the government to go big, allocate 3 per cent or more of GDP for health, “declare health as a fundamental right” and provide – Universal Health Coverage (UHC). It is time to take charge and go for big audacious goals. Strong governments can pull through the impossible and achieve results beyond the bounds of human imagination due to collective efforts and the goodwill of people. This is actually Modi’s moment in history to seize and leave an indelible mark, more importantly; it is the right thing to do.UHC, in its simplest definition means, access to quality, effective and affordable health services for all, without imposing financial burden. This can be achieved through various methods using government and private sector expertise and the costs borne by insurance premium paid by the government on behalf of citizens and other methods feasible. All citizens should be entitled to a comprehensive package of healthcare services, and have access to public health and accredited private facilities for attaining services such as diagnostics, medicine, vaccines or surgeries as an entitlement, without having to pay at the point of use.
Today, the Union budget 2018-19 took a major step towards universal health coverage, although it did not declare health as a fundamental right.
The Government of India took a definite step forward towards providing universal health coverage under the National Health Protection Scheme (NHPS). As part of this, the government will provide health insurance worth Rs 5 lakh to 10 crore poor families across India, approximately covering 50 crore people out of a 130 crore population. It will be the largest government-funded health insurance scheme to be implemented anywhere in the world as per the available statistics.
Under NHPS, the poor in India will receive medical treatment in secondary and tertiary hospitals free of cost, covered by government-funded health insurance. This will come as a boon to the poor as “out of pocket payment” was the single-most common cause of a sudden emergent financial crisis among rural folk and urban poor of India. Each year, as per available data, more than 40 million people in the country, mostly rural folk and urban poor, are impoverished, get entangled in a financial crisis and bear the burden of massive debts to access secondary/tertiary/quaternary care in India. This flagship programme, although not universal, is still welcome.
In addition, the government will set up 1.5 lakh health and wellness centres or community healthcare clinics across India under the Ayushman Bharat programme. Under this plan, these 1.5 lakh health centres will be a means to “bring healthcare closer home”, provide healthcare support for non-communicable diseases, maternal and childcare services, along with free drugs and diagnosis. The government is allotting Rs 1,200 crore for this programme and said it will ask private enterprises to join the programme as part of its corporate social responsibility (CSR) initiatives.
This flagship primary care programme needs to be analysed with data available on non-communicable diseases (NCDs) to understand how important this initiative is to the country and our healthcare policy. Successive governments had been asinine in their approach using fiscal prudence, not allocating adequate funds and policy importance to NCDs.
NCDs along with accidents today account for nearly 52 per cent of deaths and effectuate a loss of 6 per cent to our gross domestic product (GDP), as economically productive citizens die prematurely. This programme is trying to address the rising burden of NCDs and will also go a long way towards reducing the burden on our tertiary centres. Since drugs are made available free of cost, it will ensure compliance of patients and disease progression, with its complications stalled. This will help improve economic productivity of individuals as well as the GDP numbers. This confirms to the second strategy recommended earlier. Excerpt:
Second Strategic Intervention – Establishment Of National Drug Procurement Policy 1:The “Jinx of 70”, it is well established that 70 per cent of healthcare expenses are due to cost of medicines. Right to health and universal health coverage cannot be achieved without access to affordable essential drugs on a regular and viable basis. Millions of Indians could access better care, if government decides to procure generic medicines in bulk and distribute them free of cost at public health facilities. The government should establish a national drug procurement and disbursal policy with mandate to procure and provide generic medicine, surgical implants, stents, devices, suture goods etc..., to all public and private institutions participating in UHC across the country. Distribution of free medicines and treatment accessories through public healthcare systems helps increase citizens trust in our public healthcare system and in the government of the day.
Although the Ayushman Bharat programme does not completely address the much-required drug policy, it along with the Jan Aushadhi scheme should be able to complement the NHPS to move closer towards the sought-after goal of universal health coverage.
The Ayushman Bharat programme is also in sync with a part of the recommended fourth strategy, where primary care and prevention is accorded more importance than, say, for tertiary care with curative bias. Excerpt:
Fourth Strategic Intervention – Focus On Impact Areas In Healthcare: Availability and accessibility of primary care in the time and place of need especially rural areas leaves an impact, it also allows the person to suffer minimum in terms of illness and also economic losses.
Allotting Rs 600 crore at the rate of Rs 500 for every tuberculosis patient every month, to provide nutritional support, displays the sincere thought process of the government in trying to reduce the disease burden on its citizens. Tuberculosis is a notoriously difficult disease to cure and especially so when the patient’s nutritional status is bad.
The government has committed itself to opening 24 new medical colleges, including upgrading a few existing colleges and ensuring that there is at least one government medical college in every state. This again confirms to recommendations from another article of mine about medical education and regulation of practice.
Overall, the budget 2018 is path-breaking for its sheer size, coverage and amount committed per family, almost reaching out to the holy grail of universal health coverage. This along with other measures (like guaranteed minimum income to be rolled out by some states) will take India into the next generation of social security, as the country moves rapidly from a progressive developing economy to a developed one.