Govt can't bear the burden of health care alone, says Kenneth Thorpe

If your goal is to have universal health coverage, the poor have to be taken care of by the govt

Kenneth Thorpe, Robert W Woodruff professor of health policy at Emory University, has been working with the Indian government on blueprints for national-level health policy changes. In an interview to Veer Arjun Singh, he says the government and the private sector need to work together to form a sophisticated health insurance market. Edited excerpts:
 
What does India need to do to improve its health care delivery?
 
A health care problem is an economic issue too. India as an emerging economy has global aspirations. But unless it has a healthy workforce, it can’t meet its gross domestic product (GDP) targets. We have been calling for an increase in investments. In the National Health Plan, the Indian government has proposed to increase its GDP spending towards health care from 1.5 per cent to 2.5 per cent by 2025.

 

China, an economy of a similar size, spends about five to six per cent of its GDP on health care. Given the rate of India’s increasing population, is the spending target sufficient?
 
This is a good start. But one can’t expect the government to take the complete burden of health care. The private sector has to pitch in too. Right now, India spends about four per cent of its GDP on health care, if you also include out-of-pocket expenses. We think that to do an effective job of building infrastructure for better treatment, prevention and detection, the government will have to spend about seven to eight per cent.

 
Non-communicable diseases cause about 50 per cent of the total deaths in the country. Would you say that’s where the focus of all stakeholders should be?
 
It’s actually 60 per cent. And yes, this is the area with maximum chances of improvement lie. When 80 per cent of the population has diabetes and most people are undiagnosed, this is an understatement. If  you don’t treat diabetes, people could lose their eyesight or their limbs. Globally, diabetes is the major reason for amputations, outside trauma.
 
What would be an ideal health care spending model that India can adopt to counter the challenges?

 
The ideal way is to build a public-private partnership. About 70 per cent of people who live in India do not have any form of health care protection. We need the private sector to work with the government to figure out how they can build a more sophisticated insurance market.
 
A large percentage of people work in the unorganised sector. How can the government provide better health care to them?
 
If your goal is to have universal health coverage, the poor have to be taken care of by the government and the workers have to be the responsibility of the private sector. We have been aggressively promoting a public-private partnership for health insurance.

 
Even middle-income group workers struggle to pay their health care expenses. Do we need policy level changes?
 
Policy level changes in health care financing should be broad based to include the private sector. Some countries have made health insurance models related to individual incomes where the government, the employer and the employee pay towards a worker’s health insurance based on his/her income.
 
Have you made these recommendations to the Indian government and what sort of a response did you receive?
 
We have been working very closely with the Indian government on blueprints and we have been making the case that it has to invest more. The loss of income associated with the onset of diseases is very substantial as it affects both the family and the business.

 
Many of these chronic diseases are preventable. Investing to keep people away from these diseases keeps them in the workforce and can generate the maximum return on investment.
 
Aiming for a universal health care coverage for all its citizens, where should India start from?
 
I think the National Health Plan is a great starting point. The government has outlined some laudable goals of decreasing prevalence of diseases.
 
How can the government bring in the private sector?
 
In some countries, it’s mandatory to have health insurance or pay a penalty. The government and private sector can figure out what sort of a policy it should be, the diseases it should cover et cetera by collecting and analysing data at a national level.

 
Is a universally designed health care policy that is common for the working class the way forward?
 
I think it’s a good idea to have a policy that at least covers a basic list of diseases. The focus of the policy should also be on providing better primary care, so that the premiums can be kept low. That covers about 80 per cent of people’s health care needs. Start with that, and over time you can have universal coverage for more catastrophic illnesses.