Put In Place Unified National Health System

Context: There is a strong case for unified health system in addressing critical issues in Indian health system.

Issue in Indian public health systems:

• Lack of public-private sector convergence: Decrepit public sector and a largely unregulated private sector failed us during the Covid-19 management.
  • Strategic purchasing of private outpatient care services remains a distant possibility, given the under-regulated character of medical practices.
  • Public-Private-Partnerships have become tools for the government to shift the entire responsibility to the private sector, with little continuing support and monitoring.
  • Covid policy: A disproportionate share (25 per cent) of total vaccines has been allotted to the private sector despite only a handful of big players being in a position to actually absorb them.
• Inadequacy of public health insurance (PHI) schemes: By 2018, 31 state-level PHI schemes in operation along with Central scheme Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), yet,
  • As per the 75th round of NSS (2017-18), only 8.9 per cent of the population in urban areas and 12.9 per cent in rural areas were covered under government-sponsored insurance schemes.
  • Even in such forward states as Maharashtra and Gujarat, the recent NFHS-5 (2019-20) estimates indicate that less than 30% of the population is covered by any health insurance scheme.
• Poor participation from the private sector: Only around 3% of private hospitals are eligible for AB-PMJAY.
• Lack of adequate infrastructures: Only recently talks on integrating the fragmented health information systems and creating unique health identifiers gained momentum under National Digital Health Mission.
  • But their scope remains restricted, given the scarce footprint of the PHI schemes in the country.
• Issues with Public-Private Partnerships (PPPs):
  • PPPs have become tools for the government to shift the entire responsibility to the private sector, with little continuing support and monitoring.
  • Also, the PPPs have largely involved bigger players rather than the ubiquitous small players who are the true representatives of the Indian private healthcare sector.

Way forward

• Towards a unified health system: In the aftermath of the pandemic, the government shall chalk out a comprehensive, actionable and enduring plan to strategically harness the private and public sector to upgrade the health system at all levels.
• Integrated approach to healthcare: Gaining momentum under National Digital Health Mission, but a lot to be done to truly realise the scope of the idea.