India needs a renewed health-care system

Context: Indian Healthcare system needs to focus on core lessons from the pandemic and rebuild trust in public health.

Issues in the Indian healthcare system

• Inadequacy of the private healthcare sector: Maharashtra’s large private healthcare sector failed to uphold public interest, resulting in higher COVID fatality rates.
  • Despite having a similar per capita gross State domestic product, Kerala, with a strong public healthcare system, registered a COVID fatality rate of 0.48%, compared to 2.04% in Maharashtra.
• Misconduct and exploitation amidst pandemic: Caused untold distress as COVID-19 care often costs Rs 1 lakh to Rs 3 lakh per week in large private hospitals. 
  • ‘Remdesivir panic’ was linked with major overuse of this medicine by unregulated private hospitals, despite the drug lacking efficacy to reduce COVID-19 mortality.
  • Irrational use of steroids in COVID-19 patients, especially diabetics patients, contributed to the Mucormycosis outbreak.
• Regulatory gap in the private healthcare sector: Clinical Establishments (Registration and Regulation) Act (CEA), 2010 (presently applicable to 11 States across India), was not effectively implemented due to delay in notification of central minimum standards and failure to develop a central framework for the regulation of rates.
• Misplaced policy priorities: National Health Mission (NHM) allocation declined from 2017-18, resulting in inadequate support to States for core activities such as immunisation.
  • Neglect of National Urban Health Mission (NUHM): This year’s Central allocation for NUHM is Rs 1,000 crore, which amounts to less than Rs 2 per month per urban Indian.
  • Push towards privatisation: In the recently published document, ‘Investment Opportunities in India’s Healthcare Sector’ calls for further privatisation of healthcare.
    • It neglects the shortcomings of the unregulated private sector and proposes handing over public hospitals to private operators on commercial lines under the ‘Viability Gap Funding’ scheme, making the public service delivery chargeable (which ought to be free)

• Strengthen public health systems:
  • Revamp healthcare policy priorities: Consider Parliamentary Standing Committee recommendations for reaching National Health Policy targets; government must allocate Rs 1.6-lakh crore for public health during the current year (doubling of present central health Budget).
• Regulate private sector healthcare: Learning from stark market failures during the COVID-19 pandemic, comprehensive regulation of private health care in the public interest now must be a critical agenda.
  • Prevent further privatisation of the health sector: As India already has one of the most privatised healthcare systems, and any such move might benefit healthcare corporates and damage people’s health.