[op-ed snap] Universal health coverage is the best prescription

Note4students

Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: National Health Policy-2017, Clinical Establishments Act, Universal Health Care, Sustainable Development Goals

Mains level: Improving healthcare system in India


Context

Recent incidents of conduct of high-profile corporate hospitals

  1. Three recent incidents involving the health-care sector in Delhi have sparked widespread outrage over the alleged mercenary motives and callous conduct of high-profile corporate hospitals
  2. Two cases involved children with dengue who died soon after leaving these hospitals in a serious condition after their families were presented huge hospitalisation and treatment bills
  3. The third case involved a live premature baby being “declared dead” and handed over to the parents wrapped in plastic

Major issues

  1. Three major issues are involved when we assess health care: access, quality and cost
  2. Access to readily reachable, trustworthy and affordable health care is a major challenge before poorly served rural areas and overcrowded urban areas
  3. The inadequacy of organised primary health services here is compounded by a weakness at the intermediate level of care in many district hospitals and nursing homes
  4. Government institutions of advanced care suffer from low budgets and a lack of managerial talent

Steps to improving access

  1. The pathway to improving access lies in expanding the network of public sector facilities at all levels
  2. This calls for
  • higher levels of public financing,
  • investment in training and incentivised placements of more health personnel and
  • improved management through the creation of a public health management cadre

3. These measures have been envisaged in the National Health Policy, 2017 and need urgent and earnest implementation

Steps to improving quality of care

  1. There must be an emphasis on the benefit and safety of tests and treatment
  2. It must be ensured that satisfaction levels of patients, families, care providers in the nature of institutional processes as well as human interactions are met
  3. This requires ensuring conformity to accepted scientific and ethical standards
  4. The Clinical Establishments Act is a good beginning, in moving health-care facilities towards registration, ensuring compliance with essential standards of equipment and performance, adopting standard management guidelines, grievance redress mechanisms, and respecting encoded patient rights

Managing cost

  1. High out-of-pocket spending on health care leads to unacceptable levels of impoverishment
  2. Both private insurance and employer provided insurance can cover only small population segments
  3. Government-funded social insurance schemes do not provide financial protection as they cover only part of the hospitalisation cost and none of the expenses of prolonged outpatient care which forms a higher percentage of out-of-pocket spending
  4. The solution lies in doubling the level of public financing to at least 2.5% of GDP by 2019, rather than 2025, as proposed in the National Health Policy
  5. Also by pooling tax funding, all Central and State insurance schemes and employer-provided health insurance into a “single payer system”
  6. It can be managed by an empowered autonomous authority which purchases services from a strengthened public sector and, as necessary, from empanelled private health-care providers

Universal Health Care is solution

  1. The UHC provides the framework in which all three elements can be integrated
  2. It is now also enshrined in the Sustainable Development Goals
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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