During the BritishPeriod, the status of healthcare delivery system in India was not clear becausethere were not many studies done regarding the British health policies. Thereis little discussion on the “politics of health” under British rule. DuringBritish reign, there was general neglect of the public health, and the declineof India’s indigenous medical systems. Researchers are sceptical about claimsthat colonial medicine caused far-reaching changes in mortality and publichealth before 1947 as there was no concrete evidence. Before Independence, theBhore Committee report proposed a major reorientation of policy to meet publichealth requirements, though several decades were to elapse before its implementation.
The prime minister during the decade of 1970s, abolished thepatents on medicines through the Indian patent Act 1970. The government alsorestricted the import of finished formulations and introduced strict pricecontrol regulation. From being an import dependent market dominated bymultinational Pharmaceutical Companies where drug prices were higher than thosebeing charged in the United States. India managed to nurture a strong domesticmanufacturing sector for medicines. Thus, the price of essential drugs fell quitedrastically.
Unfortunately, the strong political push shown by thegovernment in establishing a domestic pharmaceutical sector was lacking when itcame to building a strong public healthcare system that could provide goodquality affordable healthcare services to its citizens. After the initial pushto establish a strong public healthcare system right in the middle of the 1970sand till the end of 1980s, there was a slow-down in government investment inpublic health, especially post liberalisation. This is best illustrated by alook at the expansion of government medical colleges. More colleges were openedby the government from 1947 till the end of 1970s than were opened in the nextthree decades till 2010.
Similarly, when it came to primary health centres and publichospitals at various levels including community health centres, districthospitals and tertiary care hospitals, government investments failed to keep upwith the increasing population. This coupled with the continuous shortage ofdoctors and other paramedical personnel including nurses and health workersthat the government failed to address, pushed more number of people to seekcare in the private clinics and Hospitals. These things led to substandardquality of healthcare, rising cost, and consequent impoverishment of people dueto healthcare cost.Over the years, there has also been a shift in the thinkingand way, the healthcare is being viewed by the government, from a publicservice and the basic right of a citizen, to seeing it as an industry. The currentNational Health Policy (NHP) envisages the private healthcare industry growing ata rapid pace from $40 billion to $280 billion over the next five years.
Healthcare industry in India is growing at a rapid pace due to investment byboth private and public sectors. The NHP talks about leveraging the for-profitmodel of healthcare services as a part of the universal healthcare access.With the government viewing healthcare as an industry ratherthan a public service, it remains to be seen what the future holds for largesections of the population without the means to purchase healthcare in a marketwhere the return on investment to shareholders could take precedence over thehealth needs of the citizens.
The government will have to show the requiredpolitical will to take tough decisions required to address the questions ofquality, cost and equitable access to healthcare services.As per the Economic Survey Report of year 2015-16 brought out byMinistry of Finance, public expenditure on health (Centre and States) aspercentage of Gross Domestic Product (GDP) for last three years are as follows:· 2013-14 – 1.2%· 2014-15 – 1.
3%· 2015-16 – 1.3 %As per recent publication of National Health Accounts –Estimates forIndia 2013-14, the total health expenditure as percentage of GDP is estimatedat 4.02% for 2013-14.
Health being a State subject, the Central Government supplements theefforts of the State Governments through financial assistance. TheCentral allocation of funds for health sector is based on the availabilityof resources and competing claims on these resources. An increased growth rateof the economy generates increased resources for funding the health sector.The average Indian pays around 70% of the healthcare costs fromhis own pocket. The out of pocket expenditure of some countries is 15% inDenmark, 18% in the UK, approximately 50% in the US and 44% in China. Thenational health policy approved by the Government plans to ensure universalcoverage and quality services at affordable cost.
To achieve this goal, theplan wants to double public expenditure on healthcare to 2.5% of GDP. This is anecessary yet ambitious target; as it is not yet clear that from where theextra resources will be mobilised from.A major change in the newhealth policy is the proposal to engage the private sector in securing nationalhealth goals by providing incentives to it. Many states, where health insuranceprogrammes allow people to choose between public and private facilities, havealready acted on this principle but it deserves to be taken further.
Overall,together with greater health expenditures, the government must mobiliseconcerted action by different agencies on the health front, given that earliernational health policies of 1983 and 2002 have failed to deliver the mandatedhealthcare for them. The population is agingall over the world and, as a result, over time every country in the world isgoing to face an increase in the percentage of GDP spent on healthcare.Governments have not been willing to make the hard decisions that would lead tomore efficient and affordable healthcare. They have tended to focus on specificgroups, for example, lowering doctors’ salaries and reducing pharmaceuticalcompany profits and hospital fees. All other countries can do all these sortsof things, but that doesn’t address the core problem of how to providehealthcare in a more efficient way.People are living longer with the advancement in the medical treatmentand technologies, and around the world, chronic diseases are rising rapidlyalongside existing infectious disease burdens, placing increasing financialpressure on already strained health systems.
TheUS Patient Protection and Affordable Care Act or Obamacare has succeeded inextending insurance coverage to millions of Americans who would not otherwisehave it.Therewas a lot of opposition to this act and the opponents said that the law imposestoo many costs on business. Insurancecompanies were backing out of participating in Obamacare because fewerAmericans than anticipated are signing up; that in turn raises insurances costsfor everyone, which then further drives down participation. For somemiddle-income Americans, the subsidies available for buying Obamacare policiesare not generous enough and the fines for not having coverage are too small toencourage them to enrol in plans.
Premiums for the policies were expected to rise byan average of 25% in 2017. This increase was predicted at the start of the law,and thus government subsidies to help pay for insurance will also increase.This will increase the financial burden on the government.In United statesof America, the hospitals are big employers, and every congressionalrepresentative in the United States has a big hospital in their district. Thepoliticians are not willing to close that hospital even if it is terriblyinefficient and unnecessarily costly to the system. As a result, suchinefficient hospitals are going to survive just because of the political gainsand those who want to reduce healthcare costs, have a difficult challenge toscale.In manydeveloping countries, it’s very difficult to close a hospital. A hospitalclosure would mean that all of the doctors and nurses, infrastructure, andeverything else that has to be maintained, would disappear.
That isunacceptable to an elected representative of that area. Also, the shutdown ofthe hospital will send negative message among the citizens as the publichealthcare system is not that much efficient in the developing countriesusually because of the shortage of resources.In an efficientand ideal system, hospital visits would be extremely rare. People would takeappropriate medicines and vaccines and see their doctors occasionally. Even ina highly efficient system, there will still be trauma, surgeries, and severeacute illnesses that require hospitalization, but the hospitalization will befor the shortest period of time.
Someunder-developed countries are thinking in a very different way about how todeliver care to the masses. So the most cost-effective solutions often come outof poorer countries. Ethiopia is one of the best example when it comes tohealthcare delivery with minimal resources. We should take some lessons fromsuch countries about how governments with very limited resources have tried toprovide services to their people.Manyof the countries have the healthcare system which is based on the concept thatthe nation should pay for everybody’s health. With time, it is becoming clearthat nations unfortunately aren’t going to be able to continue paying the waythey have. In the poorer parts of the world, the majority of healthcare costsare paid by patients.
In many of those countries the system isn’t doing what itis meant to. These systems are inefficient.InEurope, 90% of the healthcare costs are covered by the public sector. Withfree medical services provided to all citizens, the public tend to makeextensive and even excessive use of these medical services, so it is common toencounter long lines in public hospitals. In Asia, approximately 50%–70% of the healthcare costs are paidby individuals out of pocket. So, there should be the reform in both the settingswhich will solve the problems of the health system and it will be sustainablemodel for the governments of both rich, middle income and poor countrieswithout financially burdening the governments.One ofthe main problems with the governments is the limited availability of theresources. The taxes in most of the developing countries are already on thehigher sides and contrary to that the government expenditure on the publichealth is usually on the lower side.
If thegovernment will reduce taxes, then they either have to cut the servicesprovided or they have to reduce the wages or salaries of the employees. As thereduction in the tax slabs is directly proportional to the reduction in thegovernment revenue.Cost-containmentstrategies which are usually used by the governments are freezing staff payincreases, supporting increased use of generic drugs, reducing DRG payments forhospital activity, managing demand, and reducing administration costs.
These howeverare not the methods which will be helpful in the long term.One ofthe best example is of Singapore which offersuniversal health care coverage to its citizens, with a financing systemanchored in the twin philosophies of individual responsibility and affordablehealth care for all. A global commission ofleading economists found a strong connection between health and nationalprosperity. Its report stated that about 11% of the economic growth in low- andmiddle-income countries over the past generation resulted just from reductionsin adult mortality. This remarkable statistic underscores the fact that the rawmaterial of a dynamic society is the mental capacity and labour productivity ofits population. And that is tied directly to investments in health.
India has shown that inthe health arena, it can accomplish great things when the government iscommitted. The polio eradication effort is one of the most innovativelarge-scale projects of any kind. The government of India deservesinternational acclaim for engineering this success. The country turned the tideon the HIV epidemic, cutting new infections by more than half in just a decadeand averting the disaster that many predicted.But there is more Indiacan do to advance health.
Public spending on healthcare in India is extremelylow – 1.3% of GDP. This should be increased over the period of time. China (2.
5% approx.) and Brazil (5% approx.) the two other rapidly growing countries arewisely betting on health as a key component of growth.The government should investto increase the effectiveness of its health system by collecting and using datato drive accountability and results. Currently, the system does not alwaysperform optimally, but investments in monitoring and evaluation can help closethe gap between what’s possible and what’s happening now.The government can makechanges in the policies to help citizens get the most out of private health sector.
In India, the vast majority of medical care is provided by the private sector,but the sector is insufficiently regulated and the quality of care is oftenpoor.The government shouldraise awareness among its citizens about public health. For instance, poorsanitation is a massive cause of disease and malnutrition. If more peopleunderstood these connections, they would be better able to protect themselvesand their families.The driving force forthe progress in health and development will be the government of India and theIndian people. The government is investing, but it is not enough and it shouldincrease.
The polio drive was evidence that with political will, thegovernment could get the public health system to work. So, the government shouldwork towards increasing the efficiency of the health care system, bring healthreforms and should provide the affordable and quality care to the citizens ofthe country.