‘’A long-term, sustainable roadmap to achieve Universal Healthcare coverage needs to be developed’’

Given that India is already in the grip of the election fever, do you think that the new government should increase healthcare spending in order to strength the health system within the country?

Dr Rupali Basu

Government of India – Ministry of Health and Family Welfare had rolled out universal health coverage (UHC) with the private sector carving out a role for itself in the long-awaited changes that are being introduced in the 12th five-year Plan period (2012-2017). The challenges of inadequate infrastructure, fund shortages and process inefficiency in the public sector have to be addressed by mainly forging partnerships with private healthcare providers. From the year, 2000 to 2010 – despite increase in country’s GDP growth, the healthcare expenditure has reduced from 4.4 per cent to 4 per cent (Ref: McKinsey India Healthcare: Inspiring Possibilities, Challenging Journey). The decline in out of pocket payment from 67 per cent in 2000 to 61 per cent in 2010 is still high considering other worldwide figure of 37 per cent (Ref: WHO – Global Healthcare Expenditure Database).

It is important to plan for future considering the growth in urban and rural middle class and reaching out to them through extensive insurance coverage – moving it up to at least 75 per cent from 25 per cent currently. For population who cannot pay for healthcare costs would have to receive it subsidised through public provisions and government payments. Hence, government has to work in order to increase the reach of insurance coverage, be it a holistic healthcare provider and a payer. One good example of the same is RSBY.

What are the salient issues in healthcare delivery model in India today and can the new government overcomes them?

The healthcare delivery model for the country rests in following:

• Choice of roles – It is not possible to universalise the government’s role as payer or provider only in context of healthcare, just at this moment. A careful conscious and balanced choice is imperative to ensure the benefit reaches to appropriate class of population while supporting the growth of private institutions.
• Goals – A long term, sustainable roadmap for the journey to achieve the targets of universal healthcare coverage needs to be developed. These plans need to be specific to the requirements of each district of the country and customized to achieve their individual goals. The goals of public, private and primary healthcare must be incorporated where use of technology will ensure better reach.
• Funding – The government needs to assume accountability for its own budgetary outlays, private investments and address how to reduce out-of-pocket spending. GDP spending in healthcare needs to be double digit by 2025; and government‘s contribution can be 50 per cent of it.
• Prevalence – of Non Communicable Diseases (NCD) shall bloat up in next few years. It would become important that care providers develop long term and holistic care models to ensure better lifestyle, improved diagnostics and increased precision in management of events and emergencies.
• Quality – Process efficiency and quality needs to drive the core objective of healthcare. It will be important to measure outcomes in terms of health indicators for the amount of resources allocated.
• Finally, utilisation of existing workforce in optimal way

What about the manpower crunch in healthcare? How is the industry dealing with this issue?

The need of skilled people in healthcare and the details of the need of healthcare facility for the country have been worked out. The healthcare sector is experiencing significant and rapid change; but the dramatic change is yet to come. In an evolving and challenging environment, healthcare organisations need to ensure high levels of technical and professional expertise. The main crunch in this entire matter is skilled manpower. Human capital is distinctly different from the tangible monetary capital due to the extraordinary characteristic of human capital to grow cumulatively over a long period of time. The growth of tangible monetary capital is not always linear due to the shocks of business cycles. During the period of prosperity, monetary capital grows at relatively higher rate while during the period of recession and depression; there is deceleration of monetary capital. On the other hand, human capital has uniformly rising rate of growth over a long period of time because of the very nature of the foundation. This trained human capital doesn’t include only the doctors but nurses, technicians and health system managers.

Current challenges:

• There is a limited structured programme for technical people.
• Most of the people have learned by trial and error by standing behind a machine.
• Most of the training institutes don’t have any clinical field to teach/ demonstrate
• Poor quality of teaching (mostly confined to class room) so the performance is far from acceptable standard and sometimes even risky for the society
• Ever increasing gap from demand to production

Industries participation in improving technical and vocational education for the state:

• Need more number of medical, nursing colleges for the country
• Retain good teaching faculty
• Universities need to get involved to launch more number of technical or vocational courses
• Even open universities can take special initiatives to start/ increase the number of study centers for the state.

Is the current number of medical colleges enough to fill the gap?

The need of the training doctors for the country is enormous. Currently India has a shortfall of 7.5 lakhs doctors. In our country and compared to our population, the availability of hospital and doctors’ number is very less; this issue needs to be addressed immediately.

Referring to World Health Organization (WHO) recommendations, for every 1,000 people there should be one doctor. Our country will take another 15 years to achieve this standard.

As the country needs 500 more medical colleges in the next five years both private and public sector should take responsibility together. The Government constructed medical colleges are limited currently and about 54 per cent of the medical colleges are in private sector today.

India needs to add 10,000 medical seats each year (2014-19) to get at least 50,000 medical undergraduates over five years. This can only be achieved by adding 100 new medical colleges every year for the next five years- that is the big task.

Lastly, what is your opinion on VAT policy for hospitals and other healthcare providers?

As a policy, the healthcare providers are required to pay VAT on consumables, stents and implants. This increases the cost of the consumables and makes healthcare more expensive for the consumer.

All these consumables, stents etc., are part of the continuous medical service and not an over the counter product that can be purchased and used as per the service providers will and is guided by the accepted medical practice as per the standard treatment guideline. Also, patient food is as per dietary recommendation of the physician and not a sale. It is incidental to the treatment and not a sale of goods. This also needs to be outside the purview of VAT.

The principle of application of VAT in hospitals needs to be uniformed so that country looks at healthcare problems and solutions together.