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Resource centre on India's rural distress
 
 

Dream-health test for govt by GS Mudur

The Planning Commission has received a sweeping set of recommendations that proposes free health care and medicines for diverse needs to all Indian citizens, irrespective of economic means.

Whether or to what extent the proposals — described as “even bigger” than the UPA’s blockbuster job scheme — will be accepted will depend on the political and executive leadership. If the government throws its weight behind the initiative, it will effectively mean universal health care fully paid for by the state, mainly through tax revenues.

The recommendations were submitted by a group of health experts tasked by the Planning Commission to suggest remedies to improve health care services.

Known as the “High Level Expert Group” (HLEG), the team has proposed that every Indian citizen should be entitled to a national health package (NHP) of services that will be free for everyone, with no user fees even for those with the capacity to pay.

The services in the NHP are yet to be defined, and may vary across states, but are expected to cover all emergency care and most other medical conditions, from infections to diabetes and from heart attacks to cancer.

“The need for reform is inescapable,” said K. Srinath Reddy, a cardiologist who chaired the group and the president of the Public Health Foundation of India. “It’s not just the poor but even the middle class in India who are affected by health costs.”

Health economists have estimated that in recent years, 40 per cent of hospitalised persons in India have sold their assets or borrowed funds for health care, and the families of 35 per cent of hospitalised patients fallen below the poverty line after hospital expenses.

The NHP would include a range of diagnostic and treatment services from obstetric care and infant and child care to treatment for infectious diseases, non-communicable and chronic diseases, and emergency management of heart attacks and stroke. These services will be accessible through government centres and private providers contracted by the government.

Members of the group say some non-essential services such as dental implants or cosmetic surgery or intensely expensive services such as liver transplantation are unlikely to be included in the NHP.

The group has asked the government to increase its spending from the current 1.4 per cent of GDP to 2.5 per cent of GDP by 2017 and 3 per cent by 2022, and earmark 15 per cent of this spending to support the distribution of free medicines.

Tax revenues may be the primary source of health care financing, complemented by additional mandatory deductions from salaried individuals and taxpayers.

The proposals call for universal financial protection and access to good health care without involving insurance companies.

“Independent agents fragment the nature of health care being provided and this leads to high health care costs and lower levels of wellness at the population scale,” Reddy said in his presentation to the Planning Commission today.

“We have some hard figures from India that insurance does not bring health care costs down,” said Selvaraj Sakthivel, a health economist at the Public Health Foundation of India, New Delhi.

How soon and to what extent these proposals will get implemented will be a political decision, said one member of the expert group.

“This will be a big political act to pull off — even bigger than the NREGA (the UPA-initiated rural employment guarantee scheme),” said Yogesh Jain, a paediatrician and member of HLEG. “But it’s something that could help a government get an extra five years,” Jain told The Telegraph.

But members expect the proposals to be implemented in phases. “Making available free essential medicines is easily done: it could be achieved in two years. We could also begin with an NHP covering primary services and gradually expanding the list of services over the next decade,” Reddy said.

The group has also called for an increase in health staff at all levels — nurses, doctors, and community health workers — the introduction of transparent drug procurement processes, and for medicine warehouses in every district.

Members say that for universal health care to be realistic and implementable, a rational use of medicines would need to be enforced, a hitherto unachieved task despite its impacts on health care costs and drug resistance.

Public health experts believe India has to only reprioritise its government spending to increase outlay for health at least in the early years of universal health care. A World Health Organisation study has shown that the share of health in government spending has been “persistently and alarmingly low in India”.

India’s public spending is 33 per cent of its GDP, but public spending on health is only 4 per cent of total public spending. In contrast, China’s public spending is 22 per cent of its GDP, but China spends 10 per cent of its total public spending on health.

“The proposal for establishing a procurement network to distribute free essential medicines draws on a model that Tamil Nadu adopted several years ago,” said Sakthivel.

Health economists say India will also need to establish new financing and budgeting systems to streamline the flow of funds for universal health coverage.

What has been proposed?

Every Indian citizen will be entitled to a free national health package funded by the government. No user fees for even those who can afford to pay

Why is this seen as needed?

Current financial protection schemes do not cover outpatient care, medicines, and diagnosis. This contributes to excruciating personal health expenses

How bad is the situation?

20% urban residents and 28% rural residents have no funds for health care
40% hospitalised persons borrow money or sell assets
35% hospitalised persons drop below the poverty line because of hospital expenses
How fast can these proposals be implemented?

If a political decision is taken to accept the proposals, they can be implemented fully in 
a decade. But essential medicines can be made free within the next two years