Universal health scare

The country’s planners are debating how to provide healthcare to all. In a drastic shift from the 65-year-old public health system, the Planning Commission in the 12th Five Year Plan considers introducing an insurance scheme, which will allow a major role to private players. Will it work?

Vibha Varshney in Delhi, Alok Gupta in Bihar and Aparna Pallavi in Andhra Pradesh examine how the existing health insurance schemes are faring. They find there is a lot to learn from their shortcomings and successes before a new model of healthcare delivery is prescribed

 
By Aparna Pallavi, Alok Gupta, Vibha Varshney
Published: Sunday 07 June 2015

Universal health scare

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Free and easy access to healthcare for all. India has been striving to achieve this since Independence. But the country’s poor health indices remain a cause for concern. This is the reason expectations soared when the Planning Commission dubbed the 12th Five Year Plan the Health Plan. When the draft of the chapter on health was leaked recently, it raised alarm—the Commission had taken radical decisions to turn around the country’s public healthcare delivery system by giving a greater role to private players.

Crumbling health sector
 
  • In 1986-87, 31.2 per cent of the drugs prescribed in public hospitals for in-patient treatment were free. According to Planning Commission’s high level expert group (HLEG), the percentage reduced to 8.99 in 2004
  • People spent as much as 67 per cent of the treatment cost out of their pocket in 2011. Around 74 per cent of this was on medicines, HLEG says
  • Planning Commission’s July draft shows the country’s total expenditure on healthcare is about 3.3 per cent of GDP. About 32 per cent of this is public funded
  • Public health sector faces a shortage of human resources. Almost 88 per cent of posts of specialist doctors, 76 per cent of doctors, 80 per cent of lab technicians, 53 per cent of nurses and 52 per cent posts of ANMs (who offer maternal and child healthcare) lie vacant, the draft notes
 

The July draft, as it is called, suggested that India should embrace insurance to achieve universal health coverage. As of now general tax is used to meet the essential health requirements of all people. The Commission also pegged the government spending on health over five years at 1.58 per cent of GDP, ignoring the key recommendation of its own High Level Expert Group (HLEG) to increase public spending to 2.5 per cent during the Plan period. No one but the Planning Commission was happy with the draft.

The Ministry of Health and Family Welfare made its discontent clear by sending a critique of the draft to the Commission. The letter criticises the proposal to restrict the ministry’s role, saying it nullifies the success of the National Rural Health Mission. It also notes that the budget is too little.

Members of HLEG are not happy either. When the group was established in October 2010, it was assigned the responsibility of preparing a health delivery model unique to India that could help achieve the much desired universal health coverage. The group had suggested strengthening the public health system. Since India has a presence of a strong private healthcare sector, HLEG suggested that the government could contract private players to fill the gap in public healthcare delivery. Despite ambitious insurance schemes being piloted in several states as well as by the Ministry of Labour and Employment, HLEG had steered clear of insurance, saying it fragments healthcare and cannot cover all the citizens. HLEG has sent its critique of the draft to the Planning Commission.

Members of the Jan Swasthya Abhiyan, the Indian arm of People’s Health Movement, an international network of public health experts, are also against the draft. They say it is an abdication of the government’s duty and an effort to fill the coffers of the corporates.

Samrat Mukharjee

The Planning Commission is now rewriting the health chapter. A two-member committee has been set up under the National Advisory Council of the ruling UPA government to ensure that the objections raised are addressed in the final document. The Plan document is expected to be finalised by the National Development Council in October. This makes the next few weeks crucial for negotiations.

The changes being made are still under wraps. But sources say that the Commission is merely changing the language of the draft and not revising its content substantially. The latest information suggests that funds for healthcare delivery in the 12th Plan Period are likely to remain at 1.58 per cent of GDP. Insurance is likely to be the mechanism for providing universal health coverage.

The promise of free healthcare through insurance is seen as a populist move before the elections. It is said in 2007, when the ruling Congress Party launched the Rajiv Aarogyasri scheme in Andhra Pradesh, its popularity soared and the party returned to power.

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