Universal Health Coverage in India, when?

"The road to universal health care", K. SRINATH REDDY, A. K. SHIVA KUMAR, The HINDU, April 14, 2012.


“The best form of providing health protection would be to change the economic system which produces ill health, and to liquidate ignorance, poverty and unemployment. The practice of each individual purchasing his own medical care does not work. It is unjust, inefficient, wasteful and completely outmoded ... In our highly geared, modern industrial society, there is no such thing as private health — all health is public. The illness and maladjustments of one unit of the mass affects all other members. The protection of people's health should be recognised by the Government as its primary obligation and duty to its citizens.”

These are the words of the distinguished Canadian surgeon, Norman Bethune, who, in 1936, called for universal health protection in which health services would be provided to all through public funds.

He pointed out that the major causes of ill health among the poor in Canada, at that time, were: financial inability to pay, ignorance, apathy and lack of medical service. These are true of present-day India, where health insecurity continues to increase with growing economic prosperity.

WHAT IS UHC?
Universal health coverage (UHC) has now been widely adopted by Canada and many other developing countries both as a developmental imperative and the moral obligation of a civilised society. India embraced this vision at its independence.".....


..."However, insufficient funding of public facilities, combined with faulty planning and inefficient management over the years, has resulted in a dysfunctional health system that has been yielding poor health outcomes. India's public spending on health — just around 1.2 per cent of GDP — is among the lowest in the world. Private health services have grown by default, without checks on cost and quality, escalating private out-of-pocket health expenditures and exacerbating health inequity. 

While the National Rural Health Mission and the several government funded health insurance schemes have provided a partial response, out-of-pocket expenditure still remains at 71 per cent of all spending, without coverage for outpatient care, medicines and basic diagnostic tests."

..."Influential policymakers in India seem to be attracted by the idea that private health care, properly subsidised, or private health insurance, subsidised by the State, can meet the challenge.

However, there are good analytical reasons why this is unlikely to happen because of informational asymmetry (the patient can be easily fooled by profit-seeking providers on what exactly is being provided) and because of the ‘public goods' character of health care thanks to the interdependences involved. There are also major decisional problems that lead to the gross neglect of the interests of women and children in family decisions.”

It is also well known that insurance schemes (whether funded by the Central and State governments) at best provide limited health care and at worst divert a large part of the health budget to expensive hospitalised tertiary and secondary care, to the great neglect of primary care."


Link: http://www.thehindu.com/opinion/lead/article3312047.ece?homepage=true