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.