The future isn’t private

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The Hindu

An agricultural worker in Harayana with his Rashtriya Swasthya Bima Yojana card. Photo: Shiv Kumar Pushpakar

The public health care system, if adequately funded, is still the better alternative in a developing and complex country like India

The United Nations General Assembly (UNGA), by consensus, has adopted the Sustainable Development Goals (SDGs), a set of objectives meant to improve the lives of millions of poor in the world. Among these, access to quality health care and freedom from disease is of paramount importance in helping societies to develop.

Financial resources of a nation are best directed towards interventions that have an inherent potential to maximise social benefits. In this regard, access to quality health care to the population is a prerequisite to creating a just and equitable society.

Virander Singh Chauhan

India contributes to 21 per cent of the global disease burden, but has one of the lowest public health spending in the world. Although there has been rapid economic growth in the country in the past two decades, funding to public health care, surprisingly, has not been a priority for successive governments. Currently, India, one of the fastest growing economies in the world, spends only 1.3 per cent of GDP on public health. This is the lowest among the BRICS nations.

The draft National Health Policy 2015 document highlighted the need to increase public health funding to reach 2.5 per cent of the GDP by 2020, a much needed and welcome step, which however may not be sufficient, given the magnitude of the problem.

Prioritising primary care

The private sector plays a minimal role in preventive health care. Most Indians access the generally expensive private sector for curative care, even for minor ailments. Given the large population, low per-capita income and a high burden of disease in India, the country needs high-quality comprehensive primary care that is free or easily affordable at the point of service and impartially accessible to all.

It is true that the public health system in India has improved in recent years but it still remains in bad shape. The main reason for this is a highly inadequate spending and an acute paucity of trained manpower. An influx of funds to address the various infrastructural and technological deficiencies is urgently needed. The majority of the population in India lives in the rural areas and strengthening rural public health care systems should be an immediate priority.

It is not surprising that trust towards the highly stretched public health care system is eroding and driving almost everyone towards the highly unregulated private sector, where even high out-of-pocket expenditures may not guarantee quality of care. For example, in the case of tuberculosis, a number of private practitioners and laboratories continue to use inappropriate diagnostic tests and prescribe improper drug regimens, which contribute to the emergence of drug resistance without curing the patient.

The NITI Aayog is of the opinion that the private sector would need to play a significant role and has suggested the need for a universal health insurance scheme. However, insurance schemes have their limitations, such as the denial of certain services for many categories of illnesses and oversupply of some services in the private sector. We have seen such limitations in the implementation of government-sponsored insurance schemes.

For example, in 2008, the government launched the well-meaning Rashtriya Swasthya Bima Yojana (RSBY) scheme to provide health insurance for Below Poverty Line (BPL) families. The scheme provided various incentives for private insurance companies and hospitals and close to 3.6 crore Indians were insured under RSBY.

However, RSBY has its shortcomings such as the missing components of outpatient care as part of the scheme. There is also the problem of exclusion. There are BPL families who are entitled to the scheme but do not figure on the list. And then there is the inevitable exclusion of a large number of people who are only marginally above the poverty line.

Instead of subsidising private companies, the government should look to strengthen existing systems and encourage people to avail the services. The inability and ineffectiveness of the public health care system is indirectly encouraging the privatisation of health care services.

Quality care for all

The government needs to focus on developing innovative and alternative streams of revenue rather than subsidising and passing the buck to the private sector. A health cess, similar to the education cess, where taxes for certain goods and services would include a health tax component, can be considered.

The draft National Health Policy 2015 recommendation to increase public health allocation to 2.5 per cent of the GDP is late, but a welcome step in the right direction. To be really effective, the increase should have been up to 4-5 per cent. It is imperative that the government realises the centrality of health in the growth of a nation and seriously considers the recommendations made by the draft policy.

(Dr. Virander Singh Chauhan is visiting scientist and former director of the New Delhi chapter of the International Centre for Genetic Engineering and Biotechnology.)