Health for all through public healthcare

Health is wealth is not merely an oft-repeated maxim. Without health, a person cannot pursue his interests and goals with energy and enthusiasm. A study of the economic history of United Kingdom by Robert William Fogel shows that one of the major factors contributing to UK’s  progress was the steady improvement in the health of its people over the decades.

Ailments prevent people from leading fruitful lives. Availability of proper healthcare can contribute to human well-being and quality of life. But healthcare is not getting the importance it deserves in India. As Noble laureate Amartya Sen says, ‘Healthcare is one of the least discussed subjects in the country’.

India has emerged as an important location for medical tourism and patients from across the world come here for specialised treatment. But a common man in the country has no access even to primary healthcare. The choice before the poor is either to leave their ailments untreated or to resort to borrowing or selling whatever meagre property they have and become bankrupt.

According to the Planning Commission, health problems push almost 39 million people into poverty every year. Although successive governments promised healthcare to all and set ambitious targets, the commitments were seldom honoured. Budget allocations are often cut apparently due to fiscal constraints. But more than the constraints, it is a case of lopsided priorities.

Major issues affecting healthcare in India are inadequacy of hospital beds, non-availability of medicines and treatment at affordable costs, shortage of doctors and nurses, and low coverage of health insurance. If loss to the exchequer because of corruption and wasteful expenditures can be controlled, then it should not be difficult to tackle such issues.

India spends a meagre 4.1 per cent of its GDP on healthcare and is among the bottom 10 nations in public spending on healthcare of the world. As a result, private hospitals have become the primary source of healthcare for 70 per cent of households in urban areas and 63 per cent of households in rural areas (National Family Health Survey-3).

While opting for treatment in private hospitals patients have to cope with many malpractices apart from bearing the high cost of treatment. Some hospitals resort to fraudulent measures like unnecessary referrals to specialists, unwarranted investigations, procedures, and even surgeries, inflating of bills etc. Though some doctors admit the prevalence of these practices on condition of anonymity, they dare not speak out as they are afraid of harassment from hospital management.   

Whistle Blowers Protection Act of 2011 provides some protection to those who expose corrupt practices in government offices and hospitals. But as private hospitals are not covered under this Act, individuals who expose malpractices get no protection from this regulation.

In spite of this sad state of affairs, people are forced to opt for treatment in private hospitals because of overcrowding, lack of cleanliness and shortage of medical staff and medicines in government hospitals.

Notable progress
No doubt, the country has made progress in some areas, including eradication of small pox and polio, reduction in infant and maternal mortality rate, malnutrition, malaria, tuberculosis, cholera and HIV. Life-expectancy has increased from 50 years at the time of independence to 66 years. Poor patients have benefitted from schemes like  NRHM, RSBY and GSHIS.  

Draft National Health Policy 2015 says that, “Healthcare service delivery would be built on the bedrock of high quality comprehensive primary health care services that are made universally accessible, that are free and that are provided as close to where people live and work as is feasible. Regulatory framework needs reform to prevent private hospitals from exploiting patients.”

These are no doubt laudable objectives. But unless sufficient and uninterrupted fund flow is ensured and strict monitoring on spending is done, it will be difficult to achieve the professed goals. Lessons must be learnt from the experience of the 12th Plan which handed over the healthcare system to private institutions instead of developing a robust public health system.

If the goal of ‘Health for All’ is to be realised, the focus should be on preventive healthcare, immunisation, maternal health and improving staff strength and availability of medicines at PHCs. These can be achieved only if the public healthcare is given the pride of place in the healthcare system.