<p>Imagine if you could walk into any hospital (private or public) for any ailment and get world-class medical care, without having to pay a penny. <br /><br /></p>.<p>Also, imagine if you could get your children immunised with the best vaccines, subscribe to a training regimen and can get a physiotherapist for an elderly at home, again without having to pay for anything. <br /><br />You may think of it as a mere dream. But no, this is a reality in countries like England and Germany. You don’t pay for any health service because you have already paid taxes. Governments there consolidate all the resources to pay for expenses to promote, preserve and sustain the health of its citizens. This is the closest definition <br />of the term “Universal Health Coverage” (UHC).<br /><br />In India, a High-Level Expert Group (HLEG) in 2011 defined UHC as “minimum assured health services, that the government will provide to every Indian citizen irrespective of wheth-er the person has money or not.” Among many momentous recommendations, the HLEG recommended that government should increase public expenditures on health from the then level of 1.2 per cent of GDP to at least 2.5 per cent by 2017, and to at least 3 per cent by 2022. <br /><br />Notably, it recommended that the government should act as an enabler and assure healthcare to every citizen as an entitlement, which includes essential health services with strict adherence to high quality. Bringing cheer to prospective voters last year, the BJP election manifesto sounded similar to the HLEG and promised, ‘Health assurance to all Indians and to reduce the out of pocket (OOP) spending on healthcare’.<br /><br />But, what sounded positive till early 2015 took a disastrous spin with a pervasive supposition that the government will announce universal health insurance. Media reports indicated an insurance policy that would cover cashless hospitalisation for diseases contracted or injury sustained by the people. <br /><br />For, in contrast to the vision of UHC and the draft National Health Policy uploaded on Ministry of Health’s website, the NITI Aayog has opposed any further increase in investments by the government on health. This might amount to curtailing existing provisions of free drugs and diagnostics etc. <br /><br />The Aayog encourages insurance-based mechanism, with the private sector playing a predominant role in how citizens pay for health or sickness. Thus the well thought-out, well-intended, social goal of “Universal Health Coverage”, has been reduced to paltry diminutive goal of “Universal Health Insurance”. <br /><br />Individual responsibility<br />The present Indian administration has given clear signals that “health” is more of an individual responsibility than that of the government’s. The first sign appeared with the budget announcement of giving greater tax benefit for paying higher premium for health insurance. The Niti Aayog’s proposition is, hence, only a consistent approach towards promoting health insurance and private healthcare over strengthening of the public health system. <br /><br />It would be prudent here to talk about what transpired in the US over the last few decades. The insurance premium per month for a family of four wo-uld easily go over $1000 (Rs 63,000) per month. The US would spend more than one-sixth of its economy on healthcare with successive rise every year. Yet, there was no universal coverage. <br /><br />Inadequate attention towards regulating the insurance sector and high cost of diagnosis were predominant reasons for the intricate tribulations. The insurance lobby also had a marked influence on health policy, leaving out poorer and marginalised sections of the society. <br /><br />The US then attempted to reverse some of its mistakes thro-ugh an affordable healthcare act aimed to reduce excessive premium and to increase coverage. President Barack Obama had cited the example of Jayadeva Hospital in Bengaluru, a public health super speciality hospital as the model to emulate. <br /><br />However, the current policy direction in our country seems to be following the reverse path. The Indian super rich don’t need any health insurance and the marginalised cannot afford any premium (even if it is Rs 10 per month). Hence, the middle class will have to bear the maximum proportion of the pool of insurance premia in addition to their existing tax burden. <br /><br />Expecting middle class tax payers to pay insurance premium for covering healthcare expenditure of the entire country, even as the government’s investment in public health witnesses a decline is not only regressive but also an excessive step in the wrong direction. By some act of miracle, can we hope that righteousness prevails over the insatiable corporatisation of healthcare access in the country?<br /><br />(The writer is Additional Professor, Indian Institute of Public Health, PHFI, Bengaluru)</p>
<p>Imagine if you could walk into any hospital (private or public) for any ailment and get world-class medical care, without having to pay a penny. <br /><br /></p>.<p>Also, imagine if you could get your children immunised with the best vaccines, subscribe to a training regimen and can get a physiotherapist for an elderly at home, again without having to pay for anything. <br /><br />You may think of it as a mere dream. But no, this is a reality in countries like England and Germany. You don’t pay for any health service because you have already paid taxes. Governments there consolidate all the resources to pay for expenses to promote, preserve and sustain the health of its citizens. This is the closest definition <br />of the term “Universal Health Coverage” (UHC).<br /><br />In India, a High-Level Expert Group (HLEG) in 2011 defined UHC as “minimum assured health services, that the government will provide to every Indian citizen irrespective of wheth-er the person has money or not.” Among many momentous recommendations, the HLEG recommended that government should increase public expenditures on health from the then level of 1.2 per cent of GDP to at least 2.5 per cent by 2017, and to at least 3 per cent by 2022. <br /><br />Notably, it recommended that the government should act as an enabler and assure healthcare to every citizen as an entitlement, which includes essential health services with strict adherence to high quality. Bringing cheer to prospective voters last year, the BJP election manifesto sounded similar to the HLEG and promised, ‘Health assurance to all Indians and to reduce the out of pocket (OOP) spending on healthcare’.<br /><br />But, what sounded positive till early 2015 took a disastrous spin with a pervasive supposition that the government will announce universal health insurance. Media reports indicated an insurance policy that would cover cashless hospitalisation for diseases contracted or injury sustained by the people. <br /><br />For, in contrast to the vision of UHC and the draft National Health Policy uploaded on Ministry of Health’s website, the NITI Aayog has opposed any further increase in investments by the government on health. This might amount to curtailing existing provisions of free drugs and diagnostics etc. <br /><br />The Aayog encourages insurance-based mechanism, with the private sector playing a predominant role in how citizens pay for health or sickness. Thus the well thought-out, well-intended, social goal of “Universal Health Coverage”, has been reduced to paltry diminutive goal of “Universal Health Insurance”. <br /><br />Individual responsibility<br />The present Indian administration has given clear signals that “health” is more of an individual responsibility than that of the government’s. The first sign appeared with the budget announcement of giving greater tax benefit for paying higher premium for health insurance. The Niti Aayog’s proposition is, hence, only a consistent approach towards promoting health insurance and private healthcare over strengthening of the public health system. <br /><br />It would be prudent here to talk about what transpired in the US over the last few decades. The insurance premium per month for a family of four wo-uld easily go over $1000 (Rs 63,000) per month. The US would spend more than one-sixth of its economy on healthcare with successive rise every year. Yet, there was no universal coverage. <br /><br />Inadequate attention towards regulating the insurance sector and high cost of diagnosis were predominant reasons for the intricate tribulations. The insurance lobby also had a marked influence on health policy, leaving out poorer and marginalised sections of the society. <br /><br />The US then attempted to reverse some of its mistakes thro-ugh an affordable healthcare act aimed to reduce excessive premium and to increase coverage. President Barack Obama had cited the example of Jayadeva Hospital in Bengaluru, a public health super speciality hospital as the model to emulate. <br /><br />However, the current policy direction in our country seems to be following the reverse path. The Indian super rich don’t need any health insurance and the marginalised cannot afford any premium (even if it is Rs 10 per month). Hence, the middle class will have to bear the maximum proportion of the pool of insurance premia in addition to their existing tax burden. <br /><br />Expecting middle class tax payers to pay insurance premium for covering healthcare expenditure of the entire country, even as the government’s investment in public health witnesses a decline is not only regressive but also an excessive step in the wrong direction. By some act of miracle, can we hope that righteousness prevails over the insatiable corporatisation of healthcare access in the country?<br /><br />(The writer is Additional Professor, Indian Institute of Public Health, PHFI, Bengaluru)</p>
