Swapna Mitra
Group Quality Head,
Metro Hospital

Affordable and quality healthcare in India

Healthcare in India is at the crossroads with the government rolling out the biggest publicly funded healthcare plan in the world, and clamping down on prices of medical devices, even as global investments are pouring into tertiary care. Here are paradoxes that are characteristic of the system. Healthcare is a fundamental right, but it is not fundamentally right in India. The Supreme Court has held healthcare to be a fundamental right under Article 21 of the Constitution. However, historical public spending of just over a percent of GDP on healthcare has ensured that the country’s healthcare need has remained underserved and left for the private sector to service. The fundamental aspect of healthcare – primary healthcare – is in shambles. While Malaysia and Singapore already have a developed healthcare infrastructure, the healthcare sector of most of the South-East Asian countries is growing at a rapid pace. In 2019, the trend is set to continue and it is expected to see further innovations in the healthcare industry

On budgetary allocation in healthcare

Government must increase spending in the budgetary allocation for public health. A top Concern in improving healthcare services and facilities in the country relates to the budgetary allocation to the health sector.

The National Health Profile (NHP) 2018 released recently by the ministry of health and family welfare is both congratulatory and alarming. The health finance indicators along with information on health infrastructure and human resources in health reveal many steps still to be taken in the country while gains in healthcare indicators reflect progress. In this context, some pertinent questions that arise are: whether increased spending on health will show increments in human resource development in the health sector and, in addition, if the better health infrastructure will deliver quality healthcare in both rural and urban areas and, also critically, in remote areas such as mountainous terrains that are, at present, health services deficient. Simply increasing seats in undergraduate and post-graduate institutions and opening more medical colleges with the aim of improving the supply of health manpower in the country is not a holistic approach to improving healthcare facilities. Factors like accountability, accessibility, and affordability of healthcare services and related issues have to be taken care of.

It is disappointing, with multi-fold repercussions for health infrastructure and manpower in the country. In India, as health status statistics indicate, the burden of non-communicable diseases is growing while there is still much to be desired in reducing the impact of communicable diseases. The budgetary allocations for healthcare facilities and services must keep in tune with the goals of National Health Policy for the country to actualize the NHM and provide universal, equitable, affordable, quality services and infrastructure to meet the so far unmet health needs of the population

On planned budgetary allocation for the fiscal year 2019-20

Procurement of IGRT machine for the cancer hospital, new state-of-the-art cath lab, and the like.

On vision for health and family welfare and challenges you faced while implementing health services

Affordable and quality healthcare, which is accountable and responsive to the needs of the people of India, is a major challenge faced by today’s healthcare system for which health professionals have to be prepared.

On monitoring the quality of private healthcare

India needs international standards of medical facilities to offer quality healthcare services, and taxes should not become a barrier to achieving this. Ultimately, it will benefit patients – they won’t have to pay a higher price for the services and will also get the best available treatment. The Budget should focus on inclusive growth and this should be reflected in defining the Budget spends across key sectors, including healthcare and infrastructure.

On public-private partnership in making healthcare a success

Public-private partnership (P3) is one of the most promising models for financing successful healthcare innovations, note many observers. By combining public interest with private-sector research and development, P3s have injected new life into stalled projects and delivered innovative solutions to numerous industries – especially medicine.

P3s have been most successful in Canada, where they work well with the country’s single-payer health system. In the US, the P3 market is still in its early stages, but it shows promise. That promise is reflected in Canada with a history of success built on the P3, and one recent standout in Montréal.

On areas where government should invest to make healthcare available to everyone on the go

India needs to invest more in public healthcare and build a robust health delivery system in all aspects, including infrastructure and human resources, with special focus on rural areas, the WHO has said.

“We know that nations need a healthy population to prosper. Stepping up investment in public healthcare is pivotal to sustaining India’s economic growth. Investing in health is investing in India’s growth story,” Dr Henk Bekedam, WHO Representative to India, told PTI.

“We, therefore, need to and swiftly advance and accelerate progress toward universal health coverage (UHC) and the sustainable development goals, especially the health goal,” he suggested.

According to Bekedam, though India has made enormous progress in the healthcare sector in recent past, still “60 million people are in poverty through paying healthcare bills mainly because of the country’s low investment in health, inadequate financial protection, and high out-of-pocket expenditure”. He said many more abstain from health services or delay seeking healthcare due to financial difficulties.

In this context, the WHO has proposed a few steps of working with the government to position health higher on the agenda, both at the national and state levels.

On  policy interventions that the healthcare sector in the state need to align with the healthcare objectives at large at the national level

This policy looks at problems and solutions holistically, with private sector as a strategic partner. It seeks to promote quality of care; focus is on emerging diseases and investment in promotive and preventive healthcare. The policy is patient-centric and quality-driven. It addresses health security and Make in India for drugs and devices. The main objective of the National Health Policy 2017 is to achieve the highest possible level of good health and well-being, through a preventive and promotive healthcare orientation in all developmental policies, and to achieve universal access to good-quality healthcare services, without anyone having to face financial hardship as a consequence.

In order to provide access and financial protection at secondary and tertiary care levels, the policy proposes free drugs, free diagnostics, and free emergency care services in all public hospitals. The policy envisages strategic purchase of secondary and tertiary care services as a short-term measure to supplement and fill critical gaps in the health system.

Healthcare has been removed from the list of services specifically mentioned in the draft Consumer Protection Bill, in what is seen as a bid to assuage the medical fraternity which has expressed apprehensions over the law being used adversely against it. Doctors’ associations had also protested against the enhanced pecuniary jurisdiction of District Consumer Forums to entertain complaints where the value of goods or services is up to `1 crore. Currently, the upper cap is `10 lakh for district forums. Similarly, the bill proposes that the State Commission can take up complaints where the value of goods or services is `10 crore, up from the current `1 crore.

Apart from budget deficiencies, the Indian healthcare system is also suffering from the deficiencies of infrastructure and doctors. Limited doctors mean limited facilities, which are insufficient to serve our population. The already-insufficient infrastructure appears to be more inefficient with the increasing incidence of non-communicable diseases, such as diabetes, cardiovascular diseases, stroke, cancer, and others. Non-communicable diseases require long-term care and management. In some patients, long-term rehabilitation or artificial life-support may be required, which are economically draining for the patients. When quality of care decreases at home, it often results in re-admission to the hospitals, applying extra burden to already-ailing infrastructure. There was a need for something new when healthcare at home, a proven model in the Western world, entered India. Technologies like portable assessment devices, wearable devices, remote monitors, and high-definition video conferencing have made it possible to deliver 70 percent of hospital services at home with at par quality, and home healthcare companies are utilizing it completely to deliver quality care at home, which has eased some pressure on the healthcare infrastructure and changed the dynamics of chronic disease management.

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