Towards Healthcare for All

Sixty-five years after the Joseph Bhore Committee on health recommended that the State take full responsibility for providing preventive and curative services to all Indians, another opportunity to take a step in that direction is with us. The High Level Expert Group (HLEG) on Universal Health Coverage (UHC) for India, constituted by the Planning Commission, has offered a blueprint for introducing a National Health Package that would entitle all citizens to primary, secondary and tertiary care that is paid for by the state. This comes at a time when there is a momentum the world over – other than in the United States and China – to provide universal healthcare. India, which has one of the most indifferent records in the world in this area, must embark on the 10-year path laid out by the HLEG to move to universal care.

It does not require mention that the health status of India’s people is poor. There are economic, social and regional differences but the larger picture is one of high mortality (of infants, children and mothers), low life expectancy and high morbidity. Only nine out of 191 countries spend less than the 4.4% of total government expenditure that India now devotes to health. The limited volume and quality of public services has been driving people to private health services. These are booming, but the large out-of-pocket expenses on healthcare and drugs are imposing a heavy burden on patients. Such expenditure is estimated to push 30 million people a year into poverty. It is no wonder that what Indians increasingly fear is not falling ill but what they have to pay to get better. In recent years the centre has hit on insurance schemes like the Rashtriya Swasthya Bima Yojana (RSBY) and state governments on healthcare like the Aarogyasri programme of Andhra Pradesh. But the RSBY is ineffective because it is inadequate and Aarogyasri does not look beyond surgical care. Programmes like the Aarogyasri are also cash cows for insurance companies and corporate hospitals.