Finance minister announced a new health protection insurance scheme promising health cover up to 1 lakh per family and additional Rs 30000 cover for senior citizens. The catastrophic ailments are the single most important cause of unforeseen expenditure that brings poverty and indebtedness to a large segment of the population. This step was long overdue. This will be a game changer to address the treatment needs of over 40 crore population of India.  Besides this health budget has seen a rise of 13% outlay in this budget. In addition 3000 generic drug stores will  be opened under Pradhan Mantri Jan Aushadi Yojana. Jaitley also announced that dialysis equipment would get duty cuts. He announced the setting up of a National Dialysis Programme in each district under PPP. The country sees 3.4 crore dialysis sessions in 2.2 new cases of kidney failure, generally the complications of diabetes and hypertension. Each session costs about 2000/- and an annual expenditure of over 3 lacs for each patient. This step entails exemption of custom and excise duties on the equipment for dialysis. It made several provisions for the equipment required for the disabled e g Braille books.

Need for Primary care is foremost

While these are good steps, it has remained silent on improving primary health care. Wherever State governments have increased the coverage and outreach of reliable primary medical care, for instance in Tamil Nadu and Kerala, these States have health outcomes which are on a par with those in Sri Lanka and China. Thus this insurance essentially is a flawed health insurance scheme that promises access largely to specialist medical care at the secondary and tertiary levels. Expanding health insurance devoid of organized and accountable primary medical care services is like putting the cart before the horse. With the government failing to deliver the goods, the private sector health-care provider is now the new normal, despite being known for dispensing aggressive and unaffordable treatment.  India may have one government hospital bed for every 1,833 people, but the reality is that while in Goa there is one bed for 614 people, in Bihar it is one for every 8,789 people (The Lancet, November-December, 2015). The focus should be on ‘family doctor and family clinic’ to provide continuous affordable services at the door step. The NHS of England and Cuba model can show the way! While tertiary hospitals like PGI are doing good job, where should a patient go if small little medical problems arise on day today basis? Not PGI, not a corporate hospital! This can be achieved if private family doctors are supported by the Government and encouraged to set up friendly neighborhood clinics. In various areas. Similarly the importance of healthy lifestyle and preventive health cannot be overemphasized, which can be entrusted to family doctor. Patronizing and developing family physician as the sole agent of personalized primary care on the pattern of National health service of UK can go a long way in making health care accessible and affordable.

 

What are pillars of good healthcare?

There are four pillars of good healthcare- First: universal access, and access to an adequate level, and access without excessive burden. Second: fair distribution of financial costs for access and fair distribution of burden in rationing care and capacity and a constant search for improvement to a more just system. Third: training providers for competence, empathy and accountability, pursuit of quality care and cost effective use of the results of relevant research. 4th : special attention to vulnerable groups such as children, women, disabled and the aged. Will this insurance scheme be able to achieve the above mentioned objectives? Hospitalized Indians spend more than half (58%) of their total annual income on health care. More than 40% of those hospitalized borrow money or sell assets to cover expenses. At least one quarter of hospitalized Indians fall below the poverty line because of hospital expenses. In the wake of fervent assurances from the present government to provide free medicine and free diagnostic tests to all, universal healthcare through financing by insurance is a laudable step. But how will it be implemented when the amenities do not exist in the rural areas, corporate hospitals being unaffordable to most and the public facilities are hard to get?

Apprehensions exist in some minds!

The promise of universal health coverage will remain unfulfilled unless health is prioritized,” said some leaders. Total health spending of the central government will be almost at the same level as two years ago, which is “indefensible” and will likely “throw the entire government health sector into disarray. India spends just 1 per cent of its GDP on public health, less than Afghanistan and Sierra Leone. Still, India struggles to spend its allocated health funds because of red tape and bureaucratic bungling. “Nothing has been done for the heavily import dependent medical devices industry which is the fourth pillar of healthcare sector like medical education, health delivery and pharmaceuticals industry. The medical devices industry imports over Rs 27,000 crore worth of medical devices and nothing specific has been done to push up the Prime Minister’s ‘ Make in India’ initiative in this Industry, industry sector says. Why should a coronary stent cost 1.20 lacs in India when the same is costing about 30000/- in Europe? While the issue of having more doctors is well taken, the quality of doctors produced and the teaching faculty remain buried in secrecy. What is the good of having more doctors if the product is of poor quality?

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