The 12th Five Year Plan targets a long-term goal of UHC where each individual would have assured access to a defined essential range of medicines and treatment at an affordable price, which would be entirely free for a large percentage of the population. In this regard, critically discuss what ‘universal‘ healthcare means in the Indian context and what steps have been taken by governments to meet 12th plan‘s target. (200 Words)
The 12th FYP envisages bringing all Indians under UHC for a defined range of ailments at affordable prices while providing them free of cost to poor. The approach to ‘Universal’ health care in India is observed to include to two dimensions.
- Bringing all Indians under health care net.
- Providing health care to the people for all or majority ailments and diagnostic services at free or affordable price.
Whereas the first case is an absolute necessity, the second case of providing health care at reimbursed price is of critical concern as it involves pressure on fiscal resources, quality and capability of public health care system in offering such services.
The 12th plan aspirations are presently felt in
- Rashtriya Swasthya Bima Yojana which provides access to targeted poor at discount prices for specific ailments through an insurance.
- The recent budget has provided for tax exemption on premium paid for health insurance which encourages people to get insured.
- The vaccination drives conduct for children is universal in approach.
- The push towards increasing the availability of skilled healthcare workers and making it mandatory for medical graduates to work for a year in remote areas.
- The draft on National Health Policy which aims to increase the health expenditure to 2.5% of GDP and provides double coverage which is bringing all citizens into health net across all health conditions at low or free prices.
Now that states have more resources than before and greater say in scheme formulation, it is desirable states frame health schemes which suite their local conditions and take an informed decision on either providing all or specific treatments for all or targeted population at affordable prices depending on their fiscal capacity, strength of public health systems, per capita income of people and medical anthropology of that state.
Finally an ambitious project like UHC cannot be realized without strengthening the public health systems, a sector being ignored over decades, this aspect needs a urgent attention in the post-budget period.
In the opinion of many health activists, providing universal healthcare to all its citizens should be India’s priority. In this regard, where can the money for universal healthcare be found, how should it be spent and what role should the govt play? Critically examine. (200 Words)
Ways to augment financial resources:
- Improving the tax-GDP ratio. GST implementation, DTC
- India needs to increase its public health expenditure to 3% by 2022.
- Pre-deduction from salaries of those in organised sector towards UHC.
- Passing of insurance bill with health as separate insurance sector will increase insurance penetration in India
- Health cess on tobacco and alcohol as proposed in draft national health policy
- Efforts to bring people from informal sector to formal, to increase tax collection.
- Central procurement of drugs will cut the procurement and logistic cost for their equitable access at affordable prices.
- Help and assistance from international bodies such as IMF and WHO can be accessed for initiating such program.
- Grouping of large NGOs and Pvt company and the collection from Corporate Social responsibility can be allocated here.
Ways to spend:
- Strengthen PHCs to promote preventive care and stop crowding of secondary and tertiary level care
- Promotion of generic drugs, strengthening public drug manufacturers and R&D to develop new low cost medicines.
- Differential financing to states for health to reduce regional imbalance
- Promoting IEC, sanitation, vaccination such as project Indradhanush, clean drinking water supply etc.
- Generate health awareness which also includes general well being
Role of govt:
Government should play the role of guarantor, facilitator and partial service provider. It should regulate, accredit and enforce the quality, equity and accessibility in both public and private sector. It should also strengthen district hospitals. As a guarantor: Compulsory pooled funds should be created to purchase private contract services. Indian govt can follow steps of Japan and Brazil where the prices of essential tests and treatments are fixed/regulated by govt, this brings all citizens under same universal health care regime