Health care for all: Do parties care?

It is time to examine the health needs of India against the stand of political parties on health care.

As the summer temperature soars so also the heat of election campaign. Each political party is trying to out-beat the other in showing its concerns to the people of this country.

A nation to be healthy needs a good and efficient health care system. This is just common sense and does not need an economist or Nobel laureate to say so. It is time to examine the health needs of this country vis-à-vis the stand of political parties on health care. This will in turn help us question the candidates in our area when they come knocking on our doors begging for votes.

The core issue is that public health spending should be increased. Currently, our government at the Centre spends paltry one per cent of GDP on public health. India’s current public spending on health in proportion to GDP is among the lowest in the world. Just look at our neighbouring countries like Sri Lanka which spends 1.8 per cent of GDP, while it is 2.3 per cent in China and 3.3 per cent in Thailand. European nations like the UK, Spain, Germany, and Italy spend around 6 per cent of their GDP on healthcare.

The WHO recommends spending 5 per cent of GDP on public health. European countries spend less than the USA but still have excellent health services. The US ranks 37 among 191 countries in the WHO’s ranking of health care systems whereas UK’s National Health Service or France’s system was deemed by WHO to be best in the world. So the important underlying point to be noted is that a mere increase in budget will not solve the healthcare problems.

Covert privatisation

In India, most of the increased budget money will end up being used by insurance schemes, which would try to deliver healthcare through private empanelled hospitals. These hospitals select low-risk, high-profitability cases, passing on high-risk and emergency cases to government hospitals. Health care is needed more in rural areas but empanelled hospitals are more in urban areas and thus very low enrolment and usage in remote villages and among vulnerable communities.

Most national political parties have mentioned in their manifesto the need to increase health budget but end up by promising healthcare delivery through private empanelled hospitals. Instead the same resources could be used to strengthen the public health systems.

Data from the National Family Health Survey (NFHS) III confirms that the private medical sector remains the primary source of health care for the majority of households in urban (70 per cent) as well as rural areas (63 per cent). India has a vast unregulated private health care sector. According to Nobel laureate Amartya Sen, “Relying on private medical care, without the availability of public health services, allows extensive exploitation of vulnerable and under-informed patients and their families, because of the asymmetric nature of healthcare knowledge.”

There has always been a move towards overt or covert privatisation, but research all over the world shows that privatisation leads only to fragmented health systems and increasing inequity—thus the poorest suffer. Privatisation has to be stopped, and instead it is the public sector that has to be strengthened. From a patient’s point of view the completely unregulated nature of the private sector means that it is a space for irrational and exploitative practices. Unfortunately this is one extremely important area where most political parties are silent in their manifestos.

Medicines contribute to a huge expense (around 60 to 70 per cent) of any illnesses and hence it is important that adequate and quality controlled medicines are made available freely to all (not just BPL) at all public health services. This has been done with great success in the states of Kerala, Tamil Nadu and Rajasthan. So there is a need to scale it up to the entire nation. This has been strongly recommended by the 12th finance commission.

It is an awful situation that after more than six decades of independence, our political parties are not able to articulate the genuine health needs of the vast number of needy and vulnerable people. The public health needs to be overhauled as there is massive shortage of properly trained and equipped human resources at all levels of public health care, lack of human touch, shortage of infrastructure, lack of true and legitimate data regarding the disease pattern, so on and so forth.

Every political party cries loudly for the need to empower women but no one dares mention about “missing women” - Dr Sen’s original estimate of missing women in India is 37 million! And above all no political parties even make a passing mention as to how liquor (mostly illicit) has shattered not only the health of many a lone breadwinner but also wrecked families.