Affordable, quality health care for all requires more human resources and cost control
The National Health Policy 2017, which the Centre announced this week after a nudge from the Supreme Court last year, faces the challenging task of ensuring affordable, quality medical care to every citizen. With a fifth of the world’s disease burden, a growing incidence of non-communicable diseases such as diabetes, and poor financial arrangements to pay for care, India brings up the rear among the BRICS countries in health sector performance. Against such a laggardly record, the policy now offers an opportunity to systematically rectify well-known deficiencies through a stronger National Health Mission. Among the most glaring lacunae is the lack of capacity to use higher levels of public funding for health. Rectifying this in partnership with the States is crucial if the Central government is to make the best use of the targeted government spending of 2.5% of GDP by 2025, up from 1.15% now. Although a major capacity expansion to produce MBBS graduates took place between 2009 and 2015, and more initiatives were announced later, this is unlikely to meet policy goals since only 11.3% of registered allopathic doctors were working in the public sector as of 2014, and even among these, the number in rural areas was abysmally low. More health professionals need to be deployed for primary care in rural areas. Availability of trained doctors and nurses would help meet the new infant mortality and maternal mortality goals, and build on the gains from higher institutional deliveries, which exceeded 80% in recent years.
Contracting of health services from the private sector may be inevitable in the short term, given that about 70% of all outpatient care and 60% of inpatient treatments are provided by it. But this requires accountability, both on the quality and cost of care. No more time should be lost in forming regulatory and accreditation agencies for healthcare providers at the national and State levels as suggested by the expert group on universal health coverage of the Planning Commission more than five years ago. Without such oversight, unethical commercial entities would have easy backdoor access to public funds in the form of state-backed insurance. It should also be mandatory for all health institutions to be accredited, and to publish the approved cost of treatments, in order to remove the prevailing asymmetry of information. For the new policy to start on a firm footing, the Centre has to get robust health data. Currently this is fragmented because inputs from multiple sources and sample surveys are not reconciled, and the private sector is often not in the picture. To reduce high out-of-pocket spending, early deadlines should be set for public institutions to offer essential medicines and diagnostic tests free to everyone. This was estimated in 2011 to require a spending increase of only 0.4% of GDP, which is within the 2.5% that the Centre is talking about.
