Good health is one of the most fundamental and basic essential needs of all human beings. That is why, the 3rd goal of the 17 Sustainable Development Goals (SDGs) aims to ensure good health for all. Indian constitution also implicitly recognizes good health as one of the fundamental rights guaranteed under the right to life. For India to fulfill its dream of becoming a developed and prosperous nation it must take care of the most important of its resources i.e. its human capital. India is on the cusp of demographic dividend with the economically productive (15-59 years of age) portion of its population going above the 60% mark. But India can fully utilize this potential only if it is successful in providing for its population proper education, skills, nutrition and healthcare. Among all this, importance of healthcare is perhaps the highest as only a healthy person can be productive enough to fully utilize his skills. Therefore healthcare is of paramount importance for an individual to lead a fulfilling life and also for the whole nation to progress. Even with consistent economic growth in the past 3 decades, India has moved away from universal healthcare due to various flaws in its health policies.
India has a disproportionately high share of health problems and diseases like child stunting, diabetes, tuberculosis, cancer etc. Considering the heavy load of disease burden, insurance penetration and density should be high in India. In the recent round of National Sample Survey (NSS) it was found that over 80% of Indians do not have health insurance cover and that a majority of people in the rural areas utilize private sector health services. Another report said that 68% of total health expenditure of individuals comes as out of pocket expenditure. This shows that health expenditure is financed through the pocket of the patient and majority of health services are privatised in nature. This is a major flaw in India’s health policy, which has limited the access of healthcare to people with the means to afford it.
To analyze the nature of the health care sector, we can focus on the three major aspects i.e. accessibility, affordability and quality of the healthcare facilities. On all three fronts Indian health care system has had a mixed record. Accessibility to healthcare facilities is high in urban areas as compared to rural areas. The private sector does not find it viable to increase its penetration in rural areas given the low purchasing power whereas the public sector lacks resources, efficiency and enterprise associated with private sector. This is the reason why as per the NSS survey over 70% of both rural and urban people had to resort to private healthcare facilities despite higher costs associated with them.
Private sector healthcare is more costly as compared to public sector for the obvious reason of absence of state subsidy and the guiding motive of profit and hence scores poorly on the affordability parameter. Even if we go by the stringent parameters of Tendulkar methodology for measuring poverty, over 21% of Indians fail to earn enough to spend more than Rs. 33 per day. In such a situation it would be unrealistic and cruel on the part of state to expect the market driven sector to cater to health care needs of even the marginalized sections of the Indian society. Unfortunately, due to bad condition of primary, secondary and tertiary healthcare system of the government, people have no option other than to use the private sector for their healthcare needs.
Revenues of the government are meant for resource re-allocation, in order to bring up the have-nots so that they can compete with the haves. Low allocation towards healthcare shows little concern by the Government towards equitable distribution of health services. India spends less than 1.5% of its GDP on health which is lower than many of the Sub-Saharan countries with GDP much below India. In such a situation public sector healthcare facilities suffer from resource crunch and poor infrastructure as seen in public hospitals, unhygienic conditions, lack of availability of medicines at public dispensaries etc.
Despite many problems, there are efforts towards better distribution of health services among all citizens.
The government has taken a number of steps to increase the accessibility and affordability of quality healthcare for the weaker sections of society. Infectious diseases which accounted for most of the disease burden 25 years ago have been substantially reduced through mass immunization and vaccination programs and use of other appropriate treatments. Huge strides have been taken in public health in India due to effectiveness of such quality programs. Small pox was eliminated in 2014 and India achieved polio-free status in 2014. Maternal and neo natal tetanus was eliminated by August 2015. With the introduction of new vaccines and programs like Mission Indradhanush, India rightly aims to increase the immunization coverage to 90% in next few years.
Another way to ensure better health facilities for the ‘have-nots’ is by increasing penetration of health insurance in our country. Ayushman Bharat PM-JAY is the largest health assurance scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population. Thus, access of quality private services to the poor people is being thought of as the right solution to increase accessibility of healthcare.
If India wants to convert its demographic advantage into a demographic dividend, providing basic healthcare services to everyone at the primary level is the only way out. India needs a Prevention based healthcare system and not a curative healthcare system