Dr Srinath Reddy, President, Public Health Foundation of India was giving the keynote address at the Organisation of Pharmaceutical Producers of India (OPPI)’s recent Conclave on improving access, innovation and reach of healthcare in India, when he quoted Gunnar Myrdal, the Swedish economist and Nobel Laureate:
Health leaps out of science and draws nourishment from the society around it
This quote underlines the connection between health, science and society, a connection that sadly seems missing in India. While the country’s founding fathers had a vision for Universal Health Care (UHC) way back in 1947, where are we today, as we mark our 66th Independence Day? With a current infant mortality rate (IMR) of 47 per 1000 live births and a maternal mortality ratio (MMR) of 212 per 100 000 live births, Dr Reddy rightly predicts that it will be a challenge to meet national goals of 27 per 1000 (IMR) or 100 per 100 000 (MMR) by 2017.
Recognising that the Government needs a major re-think on its health policy, the Planning Commission put together a High Level Expert Group (HLEG) on UHC, chaired by Dr Reddy, to prepare a roadmap. The HLEG’s report was released last November and has since been forwarded to all state governments. Sources suspect that state governments could drag their feet when it comes to actually implementing or even discussing the recommendations.
For example, the HLEG report suggests a review of existing schemes and bringing them under a central umbrella. Politicians, with their eye on the 2014 election, will predictably see red at this recommendation, as these schemes have come in handy to woo vote banks. But given today’s economic realities, government-funded healthcare sounds like Utopia. Indeed, Dr Reddy points out that many developed countries, most notably the US and UK, are cutting back or rationalising healthcare schemes that have become debt traps.
The Rashtriya Swasthya Bima Yojana (RSYB), Rajiv Arogyasri of Andhra Pradesh and Tamil Nadu Health Insurance Schemes, which were indeed pioneering efforts at the time they were launched, are running out of steam (as well as funds). For example, the RSBY has become non-viable as claims have outstripped premia and the public sector insurer is reportedly threatening to walk out of the scheme if premia are not increased.
Moreover, there is solid evidence that these schemes do not do what they were supposed to do; i.e. reduce health spend. Studies have proved that health expenditure of poorer sections of households under these government-promoted schemes has actually risen, because these schemes do not cover outpatient care, medicines or lab tests, all of which form a larger slice of the out-of-pocket spend on healthcare.
Thus while implementing the HLEG report’s recommendations will need political will as well as fiscal heft, at both the central and state levels, there can be no doubt that the healthcare industry in India is possibly at its most important crossroads post-independence. The HLEG dedicated its report to the ‘people of India, whose health is our most precious asset and whose care is our most sacred duty’. The 2014 elections could actually work in favour of realising UHC. Will Dr Reddy and his ilk be able to ‘season’ the ambitions of our political masters with a dose of ‘healthcare’ sense?
Viveka Roychowdhury
Editor
