YouUniversal health coverage has been a bone of contention for India over the years. That is why the launch of Pradhan Mantri Jan Arogya Yojana or PMJAY in 2018 was nothing less than an important first step. Even after almost five years, PMJAY has not reached even half of its target population. Talk of health cover for the “missing middle” – NITI Aayog estimates that nearly 400 million Indians have no health cover and are too “rich” to be eligible for PMJAY – has remained just that.
now an official government document revealed that 90 million Indians spend one-tenth to one-fourth of their family income on healthcare. What is worrying is that the proportion of Indians in this category has increased between 2017-18 and 2022-23. They say Sustainable Development Goals National Indicator Framework Progress Report 2023 of the Ministry of Statistics and Program Implementation.
In the complex landscape of UHC in India, these 90 million – 90 million people – are among the best people in India who can afford to pay for health care. But these numbers are also worrying because they indicate a trend of inflation that has affected Indian healthcare (and health insurance). 52.04 Crores of Indians who can afford it know). Insurance premiums have increased significantly after the Covid-19 pandemic. Public healthcare remains, for the most part, free or highly subsidized, but quality is often poor and conditions are such that patient dignity is sometimes compromised. Private healthcare is luxurious and high-tech but also incredibly expensive; Cesarean section in a top private hospital in Delhi may cost a person around Rs.2 lakhs. The high-cost healthcare system doesn’t just inconvenience the rich; It also keeps the poor out.
Report of Ministry of Statistics It turns out that 90 million Indians spend at least 10 per cent of their household income on healthcare, while 31 million of them spend a quarter or more of their income for the purpose. To put it in perspective – In the financial year 2022-23, the central and state governments Spent 2.1 percent of the country’s GDP on health. This means that 90 million Indians spend, in proportion to their income, five times to 12 times the money spent by their governments. UHC is one of India’s Sustainable Development Goals (SDGs), and there is clearly a lot to cover before the 2030 deadline.
It is a daunting task, and this is why the linear approach to gradually expanding government healthcare to ‘deserving’ Indians is too small, too narrow and too late. need to analyze health expenditure Take a look at its individual parts and each segment through a solution lens – potential savings by investing in preventive care, better regulation of drug pricing, insurance for India’s missing middle, private sector procurement, and better regulation. Only a multipronged approach can get us there by 2030.
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promote prevention
The most effective — and perhaps, the most difficult — intervention to reduce out-of-pocket (OOP) spending would be to make health care less expensive. What if we could treat untreated high blood pressure so effectively that it would never lead to stroke management? What if we could manage diabetes so well at the primary care level that there would be no need to manage chronic kidney disease? And more importantly, what if hospitals become centers of prevention rather than treatment? This can only realistically happen if we can make it economically viable for a hospital not to implant stents but to use medication and lifestyle counseling to better manage cardiac events.
The government of the Chinese district Luohu in 2015 took a call “Shifting the Focus from Treatment to Health.” He did this by integrating five district hospitals, 23 community health stations, a precision medicine institute and several administrative units. The Luohu model “funds hospitals through the global budget and allows institutions to retain any funds not spent during the fiscal year.” Furthermore, in November 2016, “the hospital group encouraged specialists in district hospitals to set up clinics in community health stations to increase the proportion of first contacts that occur in primary health centres.”
The global budget model meant that the hospital would, at the beginning of the fiscal year, pay premiums for its enrolled patients. Now it was up to the integrated hospital/insurance corporation to use that money. This meant that the hospital now had a stake in preventing chronic health conditions from turning into catastrophic health expenditures. On the other hand, experts from the community helped strengthen primary health care. The institution of the family doctor who could have played this role has unfortunately died a slow death in India. There are examples like Luohu in the West too – like Kaiser Permanente Models of California, a care consortium that seeks to reduce health care costs through the integration of health services.
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Drug Pricing Conundrums
Have you ever thought about the business model of some pharmacies – think of some on Delhi’s Ring Road, right opposite the All India Institute of Medical Sciences (AIIMS) or around Fortis Hospital in Okhla – which charge 10-50 per cent manage to give one per cent discount on the MRP of medicines when corporate hospitals charge the exact MRP? With a fraction of the financial (and policy) heft of the hospital giants, how do these pharmacies manage to deliver such significant benefits to customers?
The answer is simple – drug MRP includes a significant element of commission for the marketing chain. Some pharmacies, in order to profit from the resulting volume of business, pass on a portion of the profit to consumers, while private hospitals do not. In the case of essential drugs under price control, the scope for paying big commission to the drug dealer is naturally limited, but apart from that there is a whole universe where the prices can be much lower if the commission of distributors and retailers is fixed. This commission is also the reason why your local chemist will often try to sell you a “different and better” medicine than your prescription or the medicine you want to buy over the counter.
But returning to the question of large hospital chains, conversations about the need to regulate private health care usually focus on the larger issues of unnecessary tests, long hospitalization periods, and unregulated procedures. This does not mean that those things do not need to be investigated or that standard treatment guidelines should be followed only in cases of violations. But the drugs used by the hospital also form a major part of the exorbitant bill we are handed. This is a fruit that can have an impact on OOP expenses at drugstores.
Increasing gas on PMJAY
Till June 30, 2023, i.e. a little over four years and nine months after PMJAY was launched, the scheme, which provides an annual family health cover of Rs 5 lakh to eligible families, has only enrolled. 23,88,07,318 beneficiaries, The scheme aims to cover 50 crores People. Raising the gas on PMJAY enrollment is important in light of the statistics ministry’s report as the PMJAY target population is one that is just one catastrophic health event away from financial collapse.
Parallelly, the government also needs to move towards providing health coverage to the missing middle class. This is difficult for several reasons. For one thing, this population may not always be satisfied to go to a government hospital and may require a minimum level of services. It is no one’s point that government hospitals need to address the issue of service delivery and quality, but until this happens, the government will have to think of innovative ways to ensure that a critical illness Do not waste years of hard work for this vulnerable section. Group. There can be many models – including interactive – and there can be many numbers for that.
But one number that definitely needs to change is government health expenditure at 2.1 per cent of gross domestic product (GDP).
Abantika Ghosh is a former journalist and author. She is currently working with Chase India. She tweets @abantika77. Thoughts are personal.
(Edited by Zoya Bhatti)