Affordable health care

Kashmir Times. Dated: 3/21/2017 11:48:07 PM

A quality health care with affordable prices for all citizens of the country requires more human resources and cost control

The National Health Policy 2017, announced by the NDA government last week after a nudge from the Supreme Court last year, faces the challenge of ensuring affordable, quality medical care to every citizen in the country. The policy decision which has been guided by the directions from the Supreme Court is not keeping with the resources that are available with the central government at present. This is mainly for the reason that the funds allocation for this key sector are minimal and do not suffice the requirements of the people. The National Rural Health Mission (NRHM) formulated a few years back for providing medical and health care for the citizens at their door steps has also suffered due to paucity of funds from the central government. The states which have a higher doctor-patient ratio also suffered on account of shortage of medicines and absence of doctors in remote and far flung areas. Even in the 21st century when health care for all has been the mantra of all the governments around the world did not match the needs of the people not only in urban areas but also the rural belts. When teeming millions of people in both urban and rural areas suffering from various life threatening diseases, India needs to do a lot to overcome these challenges. With a fifth of the world's disease burden, a growing incidence of non-communicable diseases such as diabetes and poor financial arrangements to pay for care, India brings up the rear among the BRICS countries in health sector performance. Against such a poor record, the policy now offers an opportunity to systematically rectify well-known deficiencies through a stronger National Health Mission. Among the most glaring lacunae is the lack of capacity to use higher levels of public funding for health care sector. Rectifying this in partnership with the states is crucial if the central government is to make the best use of the targeted government spending of 2.5 percent of GDP by 2025, up from 1.15 percent now. At present, although a major capacity expansion to produce MBBS graduates took place between 2009 and 2015, and more initiatives were announced later, this is unlikely to meet policy goals since only 11.3 percent of registered allopathic doctors were working in the public sector as of 2014, and even among these, the number in rural areas was miserably low. More health professionals need to be deployed for primary care in rural areas. Availability of trained doctors and nurses would help meet the new infant mortality and maternal mortality goals, and build on the gains from higher institutional deliveries, which exceeded 80 percent in recent years.
The public health care sector needs to be expanded within a short span of time for meeting these challenges and achieving these targets. In this direction, collaboration of medical services from the peripheral and private sectors is also needed to provide quality health care to all. Contracting of health services from the private sector may be inevitable in the short term, given that about 70 percent of all outpatient care and 60 percent of inpatient treatments are provided by it. But this requires accountability, both on the quality and cost of care manly in the field of diagnostics. No more time should be lost in forming regulatory and accreditation agencies for healthcare providers at the national and state levels as suggested by the expert group on universal health coverage of the Planning Commission of India more than five years ago. Without such oversight, unethical commercial entities would have easy backdoor access to public funds in the form of state-backed insurance. It should also be mandatory for all health institutions to be accredited, and to publish the approved cost of diagnostics and treatments, in order to remove the prevailing asymmetry of information. For the new policy to start on a firm footing, the centre has to get robust health data from whole of the country. Currently this is fragmented because inputs from multiple sources and sample surveys are not reconciled, and the private sector is often nowhere in picture. To reduce high out-of-pocket spending, early deadlines should be set for public institutions to offer essential medicines and diagnostic tests free to everyone all across the country. This was estimated in 2011 to require a spending increase of only 0.4 percent of GDP, which is within the 2.5 percent that the Centre is talking about. Even higher allocation may be required to set up the basic facilities in all hospitals within the targeted period.

 

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