HEATH SYSTEM IN INDIA

Access to quality health services has remained an abiding challenge for In­dia. Given our complex so­cio­economic reality and disparities in the quality and availability of health services, the need to focus on health fnancing is an important economic and so­cial imperative. The key to increasing access to quality health care in India lies in increasing the patient’s abil­ity to pay. The only sustainable way to do this is by increasing insurance cover because price capping, in a country that already enjoys the lowest prices, is simply not sustainable. The gaps Health coverage is the target of most health insurance schemes. The unfathomable fact, however, is that adequate and comprehensive coverage for a range of services and diseases remains elusive. Curative­ and invasive­interventions, such as surgeries and inpatient care, are covered in most public health insurance pol­icies. However, in spite of non communicable diseases (NCD) being held responsible for 60% of all deaths in India, health insurance schemes seem unprepared to meet this disease burden. The absence of coverage for outpatient care and pre­existing diseases is now an im­pediment to a comprehensive and afordable health insurance cover. Similarly, coverage for diagnostics and health tests remains patchy. 

         A recent study by Brookings India, “Health & Morbidity in India: Evi­dence and Policy Implications”, indicates that the lat­ter has been the largest contributor to health expenses in urban India. The country has witnessed a signifcant increase in health insurance coverage across population groups,but this is not nearly enough. The Brookings study in­dicates that in the decade from 2004 to 2014, the num­ber of Indians insured increased from 55 million to ov­er 350 million. The coverage went from 1% of the population to 15% within a decade. While universal health care through insurance remains some way down the road, the increased coverage is still wel­come. India accounts for some of the lowest health in­surance coverage among developing and low and mid­dle ­income countries. This, along with very low health spends, as a percentage of GDP, has meant that over 7% of the population is pushed to poverty on account of catastrophic health­care expenditures. This is not only unacceptable but also wholly addressable.

Need for incentives 

The current scenario in the country suggests there is adire need for a movement towards incentives for health coverage. With most incentivised health insu­rance schemes, premiums are included in the list qual­ifying for standard deductible. However, this does not benefit the non­tax paying population. Clearly, health coverage needs to be re­evaluated and health insu­rance needs to become a part of a broader social secur­ity bouquet. Similarly, innovative social insurance mo­dels also need to be explored. At present, a lot of funds are being earmarked for creating infrastructure. While this is important, it li­mits the availability of funds for health fnancing schemes and the only solution is to implement a long overdue increase in health­care budget allocation.Besides focussing on health insurance, we must add quality and outcomes to the important considerations on which a 21st century health system for India is to be created.

 As the Brookings Study indicates, catastroph­ic health expenses continue to rise in India, something that India can ill aord. But price control or even in­creased insurance coverage cannot address this and other challenges. Focus on quality, outcomes and re­liability, coupled with greater budget allocation for health care, must all be central to our combined eforts for an accessible, equitable and eective health sys­tem. Lastly, weakening our commitment to intellec­tual property rights ultimately serves to delay the ad­vent of the newest medications and technologies. Arecent study by the Commonwealth Fund on drugpricing in the U.S. vis-à-vis 10 other high­income coun­tries suggests innovative centrally negotiated cost con­trol measures and expansion of insurance cover as more eective measures to reduce out­of­pocket spend and control costs.