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Healthcare Sabha 2018 | Ethical dilemmas and emerging challenges in India’s healthcare sector


“Many successful countries who have achieved Universal Health Coverage (UHC)  have been driven by ethical concerns. So ethical dilemmas and its emerging challenges needs to be addressed,” said Sujata Rao, Former Health Secretary, Ministry of Health & Family Welfare, Government of India at the 4th edition of the Healthcare Sabha.

As the keynote speaker on the second day of the event, Rao addressed the august audience of public healthcare leaders and pointed out on the various ethical issues and emerging challenges faced by the India healthcare sector.

“Many countries like Brazil, South Africa, Turkey, Thailand, Malaysia, Vietnam and China have achieved UHC or they are in the advanced stage of achieving  UHC. For example; in Turkey and Thailand, 80 per cent of healthcare services are provided in the public sector, largely to keep the cost of care low and also to keep up the quality of care on par with the private sector. India inherited such an ethical basis at the time of independence yet we are on par with the African countries on our journey towards realising UHC due to various reasons viz. lack of healthcare budgets, corporate sector monopoly among others,” Rao said.

Briefing about various government sponsored healthcare schemes and talking about the roll out of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), Rao said, “Since hospitalisation is very resource intensive it is feared that the roll out of  Ayushman Bharat may result in the diversion of funds being spent on population health. If we really do not spend two to three per cent of GDP that is required for healthcare and if we are still stuck with 1.1 per cent then a substitution effect comes in. As people go to hospitals, the private sector will be extend bills within the specified time, if it is not reimbursed on time, penalties can be levied, so there will be a compulsion to adhere to contracts and pressures of reimbursement under government health schemes will override the focus of the public health programme, leading to ethical dilemmas.”

Discussing various ethical dilemmas that the current healthcare sector is facing, Rao also listed out few basic challenges in the health sector.

Summing up the session, Rao said, “The government should take a systematic view and needs to regulate the market. Public policy needs to ensure a system that is based on rationale care. Incentivise the providers to practice ethically, rationally and cost- effectively. We need to build an India that cares so that its people live long, are healthier and lead a productive life. They should get treatment without going through a lot of pain. We have a long way to go in the journey and we all need to take it together.”

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