We can be proud that the Right to Information, Right to Education and of late even Right of a Government Service are becoming realities than concepts ... There have been perceptible positive changes due to all such rights being made mandatory... But, what about the Right to Healthcare? For the common man, especially the economically marginalised, it is much more important than many of the rights mentioned above. Good healthcare is required to prevent illness, address diseases if at all it strikes and to alleviate pain and suffering... It is as or more important than food, clothing and shelter for the Aam Admi.
We talk a lot about inclusive growth and as part of it inclusive healthcare. This has rather become a fashion cliché now days for social scientists, politicians and planners. Political parties include healthcare routinely in their manifestos and governments promise to focus on healthcare related issues, whenever they assume office. But the reality is that healthcare is a relatively neglected area by the succeeding governments and policy makers in the 60 years after independence. While some of the states like Kerala have been an exception, national averages in many of the health indices are abysmally low. It is unfortunate that a nation which is aspiring to become an economic super power in 15 to 20 years compare to some of the sub Saharan African countries in many of the health indices.
The healthcare spent of any country is a major factor determining the quality of health care in that country. As a percentage of the GDP, we spent 4.2 on healthcare whereas USA spent 15.2 % and Germany 10.1%. Even many of the emerging economies spent much more than we spent on healthcare.
In absolute terms, the figures are more alarming as shown in the attached table, reproduced from WHO Country Report 2012 showing the 2009 statistics (Table I).
Another disturbing statistics shown in the chart depicts the out of pocket expenses of citizens of each country on health care. In countries where the % of the out of pocket expenses is low, like in UK, USA and Cuba, the citizen is well covered by the Government schemes or through insurance for healthcare. In countries like India, 60% of the expenses are met by people from their own pocket. This denotes a catastrophe in case of a major illness, in a country where more than 300 million people are below poverty line and the healthcare costs for management of major illnesses are skyrocketing. WHO has estimated that about 100 million people worldwide are pushed to abject poverty every year due to major illnesses? In India it is estimated that about 15 million people move from APL category to BPL, every year due to this. It is very common to hear people selling houses or sourcing money from loan sharks, going into downward spiral of financial catastrophe vein in our own neighbourhood, where the social insurance by relatives and well wishers are much stronger.
While everyone is aware that there is a problem, no one is able to address the issues squarely and find a solution for this very vexing issue. Unlike other issues, this is a life or death issue for many in the lower socio economic strata. . While it is definitely not an easy task, by bringing in more resources, utilization of existing resources and most importantly execution of the project with an iron will have substantial impact on this. This has to be done by the Government with the active participation of the private sector.
Following are some of the suggestions which can be considered while such a plan is being drawn
- The allocation by the Government for the health sector has to increase several fold. Presently, less than 2% of the budget is being allocated for health. This has to at least double in the next 3 years, which will aid massive inflow of funds to the government sector and increase the GDP spent for healthcare.
- There has to be significant flow into the primary health centres to improve health awareness campaigns, immunisation and other aspects of preventive care.
- In order to have facilities at government hospitals to treat serious illnesses like Cardiac, Cancer, Kidney etc, the infrastructure in these facilities has to be improved. This can be done by providing appropriate medical equipments.
- Many of the existing government hospitals at District and Taluk Head Quarters can be converted into teaching hospitals for Medical and Nursing students which will help to improve the infrastructure and patient care.
- There has to be differential tariff in Government hospitals. Those who can afford must pay whereas BPL patients should be provided free or highly subsidised treatment.
- The hospitals must use the money thus generated from the differential tariff for paying at market rate to the doctors and technical staff to attract better talent.
- Insurance schemes to cover the serious illnesses for the BPL population must be devised by the government. The substantial premiums for this can be generated by taxing some of the areas which are injurious to health like smoking, alcohol, soft drinks etc.
Our aim must be to provide health for all through a multi pronged approach with additional funding, better planning and execution in a time bound manner.