Stopping the slide of health care in India

Context: The coronavirus pandemic has revealed the deficiencies in our public health care eco-system and the inability of high cost, private healthcare system to take care of the poor and marginalised section of our society.

Issues in the Indian public healthcare system:

• High Out-of-pocket expenditure: In India, where 70% private and 30% of public healthcare exists, 80% of people don’t have any health protection, and out-of-pocket expenditure is high as 62%.
  • Unaffordability: due to profitability was driven behaviour of private sector results in nearly 70 million of the non-poor slide into poverty on a year-to-year basis
• Low public spending: at only 1.13% of the Gross Domestic Product (GDP).
• Shortage of healthcare workers: The ratio of 0.6 nurses per doctor while the World Health Organization specification is three nurses per doctor.
  • Resulting in abysmally poor health outcomes: For E.g. in Uttar Pradesh, Bihar, North Indian states.
• Inefficacy of social insurance: It has solved the pooling equilibrium problem when the majority has an affordability problem.
  • Under Ayushman Bharat, out of 12 core, only 1.27 crore people have taken advantage.
  • The inefficient behaviour which is associated with moral hazard still remains:
    • High social cost: The doc­tor and patient are not constrained by the ability to pay, and while the marginal private cost is zero, the social cost can be high.
    • Information asymmetry: between the patients and the doctors/hospitals helps in creating a supplier-induced demand.
    • Poor targeting: Any attempt to cover the non-poor and the rich will result in advantageous selection for those better-off crowding out the poor.
    • Neglect of primary health care: Insurance of secondary and tertiary care pushes out long-term investment by the state and people in primary healthcare.

Way forward:

• Encourage Primary health care: by increasing allocation three times and doubling the strength of doctors and paramedic.
• Filling the gap in human resources for health:
  • Provide Incentives
    • To doctors: in terms of salary and post-graduate preference in seat, but also penalise for absenteeism from rural posting.
    • To states: to carry out the appointments of health workers and doctors.
• Public Healthcare Centres (PHCs) should be well-staffed and well-provisioned through a reasonable fee which will cover at least part of the cost.
• Empower graduates of BSc (Nursing) to be nursing practitioners — as prevalent in many countries. From the gender perspective, too, this is preferable for maternal and child health.

Conclusion: Policymakers need to focus on the larger picture with steps being taken to reclaim the space under public care. Once the services become predictable, people will return to these health facilities.