Health Condition of India and Challenges with Suggestions:
12% of urban and 13% of rural population have health insurance coverage as per National Sample Survey.
26% of the total health expenditure in the rural households is met by either borrowing money or selling an asset and thus dragging vulnerable population below the poverty. (NSSO)
Budget allocation of 2017 to health sector when weighted with inflation is less than the budget allocation of 2011-12.
In 2005, Non Communicable Diseases( NCDs), including diabetes, respiratory diseases, cancer, and cardiovascular diseases (CVDs), accounted for 53 per cent of deaths and 44 per cent of disability-adjusted life years (DALYs) lost in India, with projections indicating a rise to 67 per cent of total mortality by 2030.
A report by World Economic Forum and Harvard School of Public Health estimated that NCDs and mental disorders would cause $4.58 trillion loss to India from 2012 to 2030.
Aim of Government as stated in National Health Policy:
Universal access to good quality health- care services without anyone having to face financial hardship as a consequence.
National Health Policy 2017:
To increase GDP spending to 2.5% of GDP from the current 1% of GDP.
Assured Universal availability of free primary health care services for reproductive, maternal, child and adolescent health.
Better access to secondary and tertiary care through strategic purchase of services from Pvt. Sector.
Universal access to free essential drugs, diagnostics, emergency ambulance services, and emergency medical and surgical care services in public health facilities.
Programmes on early screening for blood pressure, diabetes, and cancer - breast, cervix and oral.
National Healthcare Standards Organization proposed to develop protocols and standard guidelines for care.
Major negative observations.
Niti Aayog recommends that instead of relying on public expenditure, state governments should rely on Public Private Partnership and Corporate Social Responsibility to generate funds for Public health concern.
National Health Policy has called for greater role of private sector in health services.
Paucity of infrastructure and manpower to regulate PPP.
The target of NHP 2017 of spending 2.5% of GDP is half of the global average health spending.
Major Institutional Concerns on Health sector:
Public Health Infrastructure of India.
Disease profile of the country.
Human resources in Health.
Public health policy making in India.
Basic tenets of Health Service:
Equity and Justice
This means that Health services need to be accessible to all and the policies need to be make health sector accessible to every individual. One should not feel that due to poverty, they are unable to receive proper medication and are thus forced to die.
Increase health care spending to 2.5% of GDP:
Compared to countries like Thailand which spend 14% of its total public spending on healthcare sector. We are spending only 4% of our total public spending amounting to 1% of our GDP
Pay for health sector through taxes and not user fees:
User fees doesn't actually help the health care system pay for itself as it eats up the revenue by paperworks and salaries. Also, even minimal user fees deter the poor from seeking care. Thus government can consider levying a specific income tax to support the national health care programme.
Increased spending on Primary care:
The increased spending on healthcare sector should be accompanied by changes in how that money is spent. Over time, 70% of the spending should be on primary care as directing health financing mainly into tertiary care leads to not providing the population or providers with any incentive for preventive care.
Primary care is distinguished from other levels of care by the medical qualifications of the attending doctors and the sophistication of the facilities needed to provide it. Pre-natal check-ups and regular deliveries would be primary care, for example, while a cesarean-section delivery would be secondary care. Offering better primary care earlier could help reduce the number of cases where diseases or complications progress to a point where they require travel for more expensive and more aggressive treatment.
Developing All India public health service:
The committee suggested the country needs an all-India service of public health workers along the lines of the system of Tamil Nadu. More medical and nursing schools need to be set up and million more basic health workers will be required, particularly in villages
Reducing out of pocket spending:
Indian government could take a cue from Tamil Nadu, which purchases drugs in bulk and provides many medicines for free to patients. That would involve significantly increasing public spending on drugs from around $1 billion now.