Health care in India:
National/Universal health assurance scheme?
• WHO definition: provision to all people of needed health services of quality with financial production.
• 3 dimensions of coverage:
1. Proportion of people covered,
2. Range of services provided,
3. Degree of financial protection against out-of-pocket expenditure.
• Essential services, secondary health care services, emergency services – to everybody irrespective of income levels.
• Rich, poor have equal stake – rich ensure that the quality of services is sustained. (Logic of Universality)
• India has 70% out-of-pocket expenditure towards health care.
• 70% patients handled by Private sector in India.
• Insurance
Rashtriya Swasthya Bima Yojana – Labour Ministry to cover workers in the unorganized workforce.
India yet to address the financial protection part – the cost of medicines etc not covered by state funded insurance schemes.
Insurance schemes fragmenting the system by disconnecting the primary care from secondary care –
NHAM must provide primary care, connect them to secondary care under RSBY. Connectivity and gatekeeper function.
More funds needed for health care. 93% workforce in informal sector.
In terms of per capita Public financing for health – Indian govt spends half of what Sri Lanka does, a fourth of what China does and a sixth of what Thailand does.
2.5% of GDP to go into Health to achieve universal health care.
Center state Relations – Health care:
ArogyaSri : Provision of advanced medical care in hospitalised settings to poor people and other vulnerable sections. Upto 1lakh 50k per family per coverage. Things like cardiac surgery could be covered.
Cons:
1. Disconnect between primary and secondary, tertiary care (covered by scheme)
2. Lots of funds flew to Private sector hospitals while the infrastructure in Govt hospitals remained unimproved.
Schemes should be merged into one. Govt should assure portability of schemes.
GENERIC Drugs
• Compulsory Licensing:
• India should take a firm stand on its patent regime to make minor changes to the drug formula and make available costly drugs at cheaper costs.
• This forces MNCs to go in for tiered pricing – they sell drugs in India at a lower price than in the West.
• (Doha declaration), Intellectual Property Rights (IPR)
• Judicious price control over branded generics in India is also to be achieved. Pooled public procurement from the manufacturer at low cost and then making them available to the public is to be done.
• Licensing must for life saving drugs, no undue extension of patents for drugs going off patents. The govt must support the Indian generic drug industry and must ensure the quality control.
Primary Health Care:
1. MDG Goal – MMR and IMR
2. Under five child mortality rate – India is close to achieving this.
3. IMR – India might fall short because of low neo-natal (first one month) mortality.
4. MMR – might fall short here too.
5. But there is actually an accelerated decline in the mortality rates.
6. Many countries have done much better than India. Sri Lanka, Bangladesh, Nepal have done better than India. China with a fifth of India’s income was able to control under five mortality rate.
China’s Health care success
1. Before liberalization, China invested fairly in Water, sanitation, nutrition – essential things for better health.
2. Also ensured equitable access to health services. After rapid liberalization, there was some destabilization but it is being addressed now.
India:
Quality of care is missing element.