Public healthcare system has to be thoroughly revamped by the centre

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By: Dr. Arun Mitra

Report of the Parliamentary Standing Committee on Health that private hospitals have been charging exorbitantly from the patients during the COVID pandemic is a serious warning for the decision makers. If even in such situations as pandemic when there is need for a lot of empathy and sympathy, there are reports of fleecing by the corporate sector, then what must be the situation under normal circumstances? Healthcare as a profit making business, which is ruthless and devoid of any social concern is unacceptable.

Because of loss of jobs and livelihood as a result of lockdown large number of people have been pushed into severe economic crisis. Crores of them suddenly ended up without basic minimum food to sustain life. In the absence of sufficient support from the state they were left to the mercy of the social organisations for a single square meal. Under these circumstances to pay Rs.30000/- to Rs.40000/- per day in the ICU for COVID treatment is impossible and it added to their misery.

The standing committee has taken a serious note of poor facilities in the public sector health care system which has been ignored consistently by the successive governments. The committee has pointed out with pain insufficiency in the spending on public health which is meagre 1 per cent of the GDP. The committee has opined it should be increased to 2.5 per cent within two years.

In the first few decades of post-independence period healthcare was based on the principles that health has to be promoted through organized community effort. During that period much of the health care was developed in state sector with a special emphasis on the need of basic healthcare services at the community level.

But from this holistic perspective there occurred a policy shift towards health, that treats health as techno-dependent and amenable to commodification. The shift in concept is evident in the WHO itself when in 1996 it proposed a behaviourist model which stressed more on the individual responsibility for better health. So the emphasis shifted to address only population control and some selected communicable diseases at the cost of its earlier broad-based approach.

Under the influence of international monopoly corporates it took position to increase partnership with multinational companies.  As a result the institution which was supposed to work for inclusive healthcare policies took lead in destroying its own agenda set at Alma Ata in 1978. In our country influence on the policies by the World Bank is evident in 1980s whereby health came to be viewed as a profitable business.

Thus in our country we find that the public sector is now responsible for the preventive services while the private sector on the other hand is taking lead in advanced tertiary care. We have seen exorbitant growth of corporate hospitals. This advanced care is out of reach of low and even middle income group. It is being projected that the public sector health institutions have failed in providing the services, therefore need for corporate entry.

There is little talk to improve health determinants like improved sanitation, clean drinking water supply, housing, job security and increase in capacity to spend on nutrition.  No wonder the government recognises the fact that every year 6.3 crore people are pushed below poverty line because of Out of Pocket Expenditure (OPE) on health. Even the Ayushman Bharat covers only 50 crore people out of 138 crore and that too only for those who are admitted for indoor care in the hospital. The patients requiring only OPD care are not covered.

As a result the already marginalised sections of the society have been further excluded from quality healthcare benefits. Their inability to pay is pushing them to buy loans for health. There is need for reversal of these policies to make health care a social responsibility with state taking effective intervention at all levels to ensure healthcare for all. It is the duty of the public health and social activists to educate people on the issues of their rights to health in proper perspective.

Health is the basic human right. Every person has the right to live a healthy life and contribute effectively to the society’s development. As right to health is included in the directive principles, it becomes the duty of state to provide comprehensive universal healthcare to all citizens. It has to ensure prevention of disease, promotion of good health and rehabilitation of the diseased and the infirm.

Various studies have concluded that to ensure comprehensive primary healthcare there is need to enhance public spending on health to minimum of 5 per cent of the GDP. As per the National Health Accounts (NHA) Estimate for 2014-15, the Government Health Expenditure (GHE) per person per year is just Rs.1108/-. This is in contrast to the Out of Pocket Expenditure (OPE) of Rs.2394/- which comes out to be 63 per cent of total health expenditure which is Rs.3286/- per person.  Even this expenditure is not homogenous.

The spending on health varies on socio-economic status, gender, religion, caste and geography. The average share of OPE on health care as a proportion of total household monthly per capita expenditure was 6.9 per cent in rural area and 5.5 per cent in urban area. Flaws in planning and implementation of the policies have been pointed out by the Comptroller and Auditor General of India (CAG) in 2017. The audit pointed towards inadequate funding, under-spending of available financial resources, delays in transfer of funds, diversion of allocated programme funds, limited capacity to spend due to shortages in infrastructure and human resources among other issues.

To improve the health of the people drastic steps need to be taken at various levels. Health should be declared a fundamental right irrespective of religion, age, sex, caste and socio economic status. The government owes its responsibility to deliver health to all by ensuring universal access to quality healthcare, education and other day to day needs. For this there should be continuous evaluation of health status of the people. Health should get proper place in the political agenda and the policy making bodies.

Certain steps that need urgent action is the rationalization of drug prices. Regulate drug prices in line with the rationalization of trade margins in medical devices.

Free medicines and investigations in all public hospitals on the lines of Tamil Nadu, Kerala and Rajasthan should be taken as an example. The government should ensure to increase the public expenditure on healthcare from 1.1 per cent to 2.5 per cent of GDP immediately and then increase it to 5 per cent in subsequent five years. (IPA Service)

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