The role of government is particularly important in a developing country like India where private infrastructure in healthcare is still developing and a huge part of the population subsists below the poverty line. Despite this, the healthcare spending in India is much below what is needed for optimal outcomes.
Healthcare spends and GDP growths are directly correlated. For our nation to progress at the planned 8-10 per cent growth rate, we will have to continuously invest in healthcare infrastructure, medical training and support services. The Indian government spends barely one per cent of GDP on health, even though the stated aim for many years has been to gradually take this figure to three per cent.
The result is predictable: terrible disparities and inequity in Indian healthcare, with vast areas of the rural hinterland underserved by the healthcare system and an absence of preventive healthcare infrastructure throughout the country.
Low spending on healthcare is one of the major causes of high infant and maternal mortality rates. India is home to the greatest burden of maternal, newborn and child deaths in the world: around 309,000 babies die within 24 hours of birth; 56,000 mothers die every year. India, in fact, accounts for one out of every three maternal deaths in the world.
The low spending on healthcare by the government has another serious consequence too: a very high out-of-pocket expenditure for the masses. More than 70 per cent of all spend on healthcare in India is funded by the citizens themselves, with the majority of it going to meet the cost of medicines. This is a situation unique to the country and inherently regressive. It imposes a heavy financial burden on people. About 39 million Indians are forced into poverty each year as they go bankrupt trying to meet medical expenses. There is no social security net and the spread of health insurance is negligible among the population.
Healthcare should be made affordable
Affordable universal healthcare is the Holy Grail that India should urgently seek, but going by the current trends, such an arrangement seems decades away from fruition. The National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojna (RSBY) are commendable initiatives by the government, but they do not have much of an impact in increasing public health expenditure as yet. The central and state governments need to strive towards combining the already existing public health insurance schemes into a proper system of Universal Health Coverage (UHC).
Medical education and training
The Indian government also needs to spend much more on healthcare so as to increase the avenues for medical education and training. The number of PG and superspeciality seats is severely low in India compared to the global average. This scarcity of opportunities for higher medical education lies behind the shortage of medical specialists in the country. This shortage can also be addressed by training and empowering the nursing and paramedical staff in India to be at par with the medical staff at other countries like US and UK.
The government also needs to look beyond cure to establish a system of preventive healthcare for citizens. Preventive health programmes for non communicable diseases (NCDs) like diabetes, cancer and cardio-vascular diseases which are driven by ageing, rapid unplanned urbanisation, and the adoption of unhealthy lifestyles, are very cost effective and offers much higher returns. It has also become absolutely essential in the backdrop of the alarming rise in non-communicable diseases. To tackle NCDs in India, the government should plans to scale up the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) to cover all districts in the country.
Promoting healthy lifestyles
It is also imperative that the next government take concrete actions vis-a-vis prevention, awareness, and adoption of healthy lifestyle. First, the government must identify and implement priority actions in non-health sectors like trade, taxation, education, agriculture, urban development, food and pharma production that can allow for substantial health gains, especially for the poor. For example, policy instruments designed to encourage health sensitive urban development should be part of the solution.
Public private participation
The way forward is to encourage the public-private-partnership (PPP) model which until now has not been much of a success in India. According to one estimate, only about 1 per cent of all PPP projects in India relate to healthcare. To give PPPs a boost, the government needs to put in place an enabling policy framework for multiple stakeholder PPPs and bridge the trust deficit between the parties. Tax breaks, reduction in duties and policies should be introduced to encourage expansions in tier II and III cities.
The Indian government’s decision last year to more than triple the budget outlay for the healthcare sector in the 12th five year plan (2012-17) is therefore welcome. It would help bring down the out-of-pocket healthcare expenditure of people and take the government healthcare spending to 2.5 per cent of the GDP.
The government has also announced plans to launch district-wise pilot programs of universal health coverage, set up four more AIIMS-like centres in various parts of the country and provide free medicines through a central procurement agency. Now, it needs to walk the talk so that India can emerge on par with other BRICS countries in terms of health parameters of the society.
– Suresh Soni, Chairman and CEO, Nova Medical Centers