Reforming Healthcare

By GovernanceToday
In Health
October 8, 2014
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A Challenge for PM

Gujarat, under Narendra Modi’s chief ministership, saw significant improvement in the healthcare sector and, now, it’s the time for the whole country to see the vision of the PM as a game changer in providing healthcare to all…

MORE THAN 100 days of power and one of the biggest newsmakers, Narendra Modi as Prime Minister has set lots of hopes to common people. He knows well the language of general masses and the audience to whom he is speaking. For the party, it was a significant victory in three decades, and for the nation, it is a harbinger of good things to come. Now, the time has come when the PM and his Cabinet have started facing the challenges of expectations that were set by the  media and his supporters. Considering the mandate the BJP received, it becomes imperative for the new government to deliver on its promises. The expectations are high from the new regime as the saffron poster-boy has taken charge of the country at a very challenging time.

HealthcareWith many challenges in the row, a key one this government will be facing is: Healthcare. While World Health Organisation’s 2000 World Health Report ranked India 112 out of 190 countries, the  key questions in Modi’s mind would be like: How to provide healthcare to all? What can be done to balance the reach of healthcare to rural and urban masses? What will be the major roadblocks in achieving this? And many more.

As far as the healthcare sector is concerned, the condition is really worrisome and here are some concerned areas, where the government has to look up.

 

Urban versus Rural
Today, the urban health sector has seen an enormous growth in private hospitals giving multi-specialty facilities. It has welltrained  medical professionals and proper and easy access to preventive medicines, diagnostics and technology, which are a result of better profitability for investors. In contrast, the situation is entirely different in rural areas. Almost two-thirds of the babies in India’s villages are born without the help of skilled health personnel. Rural population, which comprises almost 70 per cent of the populace, mostly relies on alternative medicines and government programmes in health clinics, as they have no or limited access to hospitals and clinics.

Primary Healthcare and Infrastructure India though, having enormous growth in private hospitals, lack in providing basic facilities to the areas of HIV, malaria, tuberculosis, and diarrhoea. Still, children are born malnourished and mortality rate is high. Unfortunately, even today the population in rural areas has lesser access to sanitation and drinking water. Hygiene is one of the major concerns. For primary healthcare, the Indian government spends only about 30 per cent of the country’s total healthcare budget. As said by the experts, this problem can be addressed by taking care of the infrastructure, standardising diagnostic procedures, building rural clinics, and developing streamlined health IT systems, and themost important– bringing more skilled professionals into primary set-ups.

The government may not be able to immediately construct health facilities in rural areas, but they can partner with several private healthcare providers and non-governmental organizations working in the rural areas, in order to bridge some gap in healthcare accessibility between rural and urban areas. Moreover, there are multiple schemes addressing the same problems. The Janani Suraksha Yojna ( JSY), Janani Shishu Suraksha Karyakram ( JSSK) and Indira Gandhi Matritva Sahyog Yojna (IGMSY), all cater to the needs of the same group of beneficiaries. It is important that such multiple schemes are identified and consolidated into one. This would lead to reduced financial burden on the government, and also benefit the intended beneficiaries.

Lack of Health Policies:
While there is a huge gap between the urban and rural health sector, out-of-pocket expenditure is around 70 per cent, leaving many to sell their property and lands and bringing others under huge debt.

Indian populace has no proper payment arrangements and the hospital and medication charges go straight through cash flow. Over the last few years this market has emerged as one of the fastest growing business segments in India. Most of the health insurance market cater to the high income, middle and urban population and according to the World Bank and National Commission’s report on Macroeconomics, only five per cent of Indians are covered by health insurance policies. The gap between healthcare expenditure and that covered by health insurance in India is huge, up to USD 57 billion. This is projected to exceed up to USD 200 billion by 2020, which presents a huge opportunity for health insurance to emerge as a viable financing mechanism for growing healthcare sector.

However, despite the best efforts by the regulator, the government and industry stakeholders, the health insurance sector is gripped by a couple of challenges; primary among them being high incidents of fraud claims, lack of standard practices across the industry and long turnaround times for claim settlements, hence keeping the policy holder waiting and dissatisfied. Besides, lack of understanding of product features and perceived apprehensions in claim procedures and settlement further demotivate consumers from buying a health cover.

Growing Pharmaceutical Sector
The Indian pharma industry has been growing at a compounded annual growth rate (CAGR) of more than 15 per cent  and has significant growth opportunities. However, for the industry to sustain this robust growth rate till 2020, companies will have to rethink their business strategies. They will have to adopt new business models and think of innovative ideas to service their evolving customers faster and better.

DISTURBED MEDICAL DEVICES ACT The medical devices market is one of the most un-regulated markets in the country. There are no prescribed “gold standards” for manufacturing, no data on Indian studies for “safety standards”, no studies showing efficacy and even indications of use in India, no MRP is ever fixed and even the variations in cost prices is very wide. This scenario is made worse by unscrupulous vendors and manufacturers offering incentives to doctors for use of their products. Therefore, it is in the larger public interest that the Parliament, under the new government, enact a law to bring under its control the safety and performance of all medical devices which will be administered through the regulatory body.
Given that corruption and mismanagement is endemic and all pervasive, it is very tough to say that how effectively the government will be able to enforce the new drug programme. Instead of dealing on a case-to-case basis, India needs to have a policy that will bring more and more people under medical cover.  Though generic drugs are the answer to better healthcare for many, it needs an efficient procurement, distribution and tracking systems to ensure that drugs reach the
people who need them and are not stolen by officials and sold outside.

Conclusion
It’s not too long when the country was abuzz with the fascinating tales of India becoming the superpower. Though it’s
a reality for urban people who believe growth means development of corporates and infrastructure, the health is on backburner. They argue that the country faces bigger challenges such as economic development, infrastructure, jobs and border disputes. Whilst, a country which cannot ensure basic healthcare, education, housing and food to its citizenry it cannot be called a developed nation.

In all the Union cabinet meetings, Modi discussed the top priorities of the new government. The top priorities included development of education, health, water, energy and road infrastructure and one can easily browse through the PM’s website which has a section on his achievements in these sectors.

Our health sector is beleaguered with multitude of problems. Reducing corruption in the healthcare should be the first priority of the government, because no schemes or reform measures will work until the corruption is stamped out of the system. The Union Health Minister, Dr Harsh Vardhan, needs to take all these into consideration. So, the focus, now, is on the PM and the Health Minister. A medical professional himself, Dr Vardhan shot to fame after undertaking the most popular “pulse polio drive” when he was the health minister in Delhi government.