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HOPS as a route to universal health care -Jean Drèze

-The Hindu

‘Healthcare as an optional public service’ would ensure the legal right to receive free, quality care in a public institution

The lingering COVID-19 crisis is a good time to revive an issue that is, oddly, slow to come to life in India — universal health care (UHC). Meanwhile, UHC has become a well-accepted objective of public policy around the world. It has even been largely realised in many countries, not only the richer ones (minus the United States) but also a growing number of other countries such as Brazil, China, Sri Lanka and Thailand. Some of them, such as Thailand, made a decisive move towards UHC at a time (20 years ago) when their per capita GDP was no higher than India’s per capita GDP today. The time has come for India — or some Indian States at least — to take the plunge.

The basic idea of UHC is that no one should be deprived of quality health care for the lack of ability to pay. This idea was well expressed — in archaic words perhaps — by Aneurin Bevan, the fiery founder of the National Health Service (NHS) in Britain. “No society,” he said, “can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.” The same idea inspired the Bhore Committee report of 1946, where a case was made for India to create its own NHS-type health-care system. 

 Routes to UHC

In concrete terms, UHC typically relies on one or both of two basic approaches: public service and social insurance. In the first approach, health care is provided as a free public service, just like the services of a fire brigade or public library. If this sounds like socialist thinking, that is what it is. Interestingly, however, this socialist project has worked not only in communist countries such as Cuba but also in the capitalist world (well beyond the United Kingdom).

The second approach allows private as well as public provision of health care, but the costs are mostly borne by the social insurance fund(s), not the patient, so the result is similar: everyone has access to quality health care. Social insurance is very different from a private insurance market. The simplest variant is one where insurance is compulsory and universal, financed mainly from general taxation, and run by a single non-profit agency in the public interest. That is how it works in Canada (province-wise), and to varying extents in other countries with “national health insurance” (e.g., Australia and Taiwan). This single-payer system makes it easier for the state to bargain for a good price from health-care providers. But some countries have other models of social insurance, based, for instance, on multiple non-profit insurance funds instead of a single payer (Germany is one example). The basic principles remain: everyone should be covered and insurance should be geared to the public interest rather than private profit. 

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