Massive mandate that Modi government has got from the people demonstrates that people have faith in the government. The government is better placed to take some long pending issues impacting long term issues facing the country.
Health and Education are two such issues which need to be addressed immediately.
It puts us to shame that India figures extremely poorly on all health index and it is not surprising when the government of the day is ready to spend only miniscule amount of just about a percent of GDP.
Overall spend of around 5% of GDP is primarily dominated by private spend that people have to shell out. No wonder, one of the major reasons of impoverishment in our country is the expenditure on health care. If we look at the data from top 20 countries (OECD data), one thing that hits us is the low proportion of public spending on health in India. The government has literally left people to “die”.
Some Hope but not enough
The announcement of Ayushman Bharat plan (common health insurance plan) by the government in its previous term is a small step in the right direction. This is definitely going to ameliorate some of the pain that people go through to manage the ever increasing health care cost. Some of the reports suggest that the offtake from the insurance plan has been very impressive which means people are using it and getting benefitted. The only caution that I would like to mention here is about proper targeting.
Insurance is just one side of the problem and in a multidimensional problem scenario, if we only address one part of the problem, it always has the tendency to reflect in the other dimension. Insurance only caters to the demand side of the puzzle. In absence of any intervention in the supply side, what has happened is that the increased demand has increased the prices of available health services. The nexus between insurance agents, health service providers, pharmacies and pathologies have created an inflation in the prices. Government is doing its best to control the prices of essential drugs through price control, however, controlling the prices of services (which is the major part of the healthcare cost) is almost impossible.
The supply problem
Health care industry has been seriously impaired by supply side constraint since decades. Before the dawn of modern medicine in India, it always had a well networked system of local medical practitioners (Vaidyas and Hakims) who were linked and could refer and consult each other. There was a social mechanism to pay for the services and the moral codes always ensured that poor and needy are looked after. The profession itself was treated with great respect and the state and the local power centers always made sure that these practitioners are compensated and taken care of. The system of education was through family apprenticeship which allowed some mobility and flexibility. However, it catered to the demands well and was able to keep the health index of this country better than any other developed countries of today ( Source – Indian Healthcare sector Report).
Post-independence, the traditional system was decimated and adequate system was not there. The new government in Independent India focused more on Engineering and Sciences to speed up the economy and somehow ignored the entire health system. With only about 55,000 medical college seats both in public and private sector, the shortage of doctors is evident in every place. Those who become doctors hardly ever think of serving rural and semi urban areas and the shortage in those areas are immense. Most of the private colleges consider medical education as a business. Government spending on quality medical education and research is abysmally low. Those who are there do not want to serve at least 80% of the country where at least 65% of population lives. A poor person in a village at the time of any
emergency or even small ailment has to think about spending more money on transport than on the medicine. This has led to proliferation of the quacks and the local untrained medical service providers who have made this a business and who put peoples’ as well as entire community’s life at risk. Major reason for multi-tier antibiotic resistance in India is the availability of antibiotics freely and lack of any medical protocol with respect to the use of these medicines. If one could estimate the number of deaths due to primary care.
In such a supply crises and increased demand, the private sector health care providers are raking profits. A report by Scross.in (https://scroll.in/pulse/845539/private-sectors-profits-in-healthcare-soar-as-indian-government-investment-stagnates) suggests that the private hospitals and other healthcare service providers are increasing their profits in absence of any controls and regulation.
A reform is needed
One of the legislative impediments that is hampering the growth of this industry is that health is in the state legislative list. This limits centers ability to legislate and influence. Health has regional and national character and it is logical that this should be looked at with a national lens while states have the ability to do what they want. My request to the government is to work on making health a concurrent subject. The government has the mandate and the will power to do this.
Health as a Mission
The government should also benchmark key health parameters and should work on a health mission mode to achieve targets. It needs to seriously work on the supply side of the problem and ensure that there is a primary healthcare is available to all its citizens. In order to solve the supply side problem, the use of tradition medicine and practitioners should be encouraged, however, it is important that there are regulatory mechanism built to control increase in scrupulous elements duping poor people. The use of health workers ( eg. Anganwadi workers) for primary health care is to be streamlined.
Health as a national agenda.
Prime Minister Modi has been very good at creating national agenda like Clean India, Open toilet free India etc. He should also encourage healthy India as a national slogan. He, who is a Yoga practitioner and has kept himself fit, should be a role model for a healthy India campaign.
It only a multipronged strategy that will ameliorate the situation and it should be done sooner than later lest this becomes a national crisis.