'Healthcare for All' welcome, but proposed strategy inadequate

India Health Progress, an initiative started a year back, supports all efforts to provide access to healthcare for all citizens. But the proposed strategy of taxing tax-payers for this may not be the best option on two counts -

Imposing another tax on the few who pay taxes sends the wrong message to diligent tax-payers.

A 1% cess would only yield about Rs 9,000 crore this fiscal. This barely augments healthcare coffers for a nationwide initiative that would require 10 times as much.

Besides, hiking healthcare’s public spend from about 1.4% of GDP to 2.5% by the end of the 12th Five Year Plan (2012-17) and up to 3% at least by 2020 would still be insufficient. By 2017 and 2020, the funds required would have increased beyond present estimates.

The Government should therefore seek other options to raise the requisite funds.

Mobilization apart, the execution and outcome counts. For this, the quality of care is crucial. We need to recall that India’s primary healthcare system has been found wanting due to non-availability of drugs and the perennial paucity of personnel. The ultimate success of a national healthcare program depends on the model adopted. India needs to create its own innovative model to ensure efficient healthcare delivery, particularly against the backdrop of all-pervasive corruption that makes public projects leak like a sieve.

To prevent pilferage, healthcare programs can be linked to the ongoing national UID (Unique Identification) project. Using biometrics and other body identification tools, UID is building a countrywide repository of all citizens. Healthcare programs linked to it could create a robust monitoring mechanism to minimize misuse of funds. Once all information and funds transfers are available online, real-time data would reveal the quantum of funds transferred to each individual or entity, including details on amounts utilized or lying unused. Real-time tracking would make it easier to monitor funds usage and permit timely interventions by regulators, if needed. This system of disbursing and accounting for funds could be standardized across India, preventing attempts at various levels to subvert this for pilferage.

Healthcare delivery could follow a cradle-to-the-grave model covering in-patient, outpatient and preventive care, comprehensively serving all sections of society – poor, middle class or rich. To make sure healthcare costs are manageable, whilst morbidity and mortality rates are controlled, the focus would need to be on preventive rather than curative healthcare. Health insurance should also be promoted in a big way, since it has a major impact in boosting healthcare access and lowering treatment costs. With less than 15% of the total population covered by some form of health insurance, public or private, the potential here is tremendous.

Finally, to ensure that the “Healthcare for All” plan succeeds, healthcare should be shifted from the State List to the Concurrent List. Else, execution will fail in errant states and dent India’s overall success rate of universal healthcare access.

—Aman Gupta, Principal Advisor – India Health Progress