Despite sustained economic growth and development in India, it still has a long way to go vis-à-vis healthcare financing. There has been no considerable increase in the healthcare expenditure and it currently stands at 1.2 to 1.5 percent as compared to a global average of six percent of GDP. This is in contrast to other developing countries like Nepal (2.3 percent), China (3.1 percent), Sri Lanka (2.0 percent) and Bhutan (2.6 percent) as well. To attain the goal of equitable healthcare by 2022, India has to implement Universal Healthcare Coverage effectively and ensure that it takes the financial burden off the shoulders of Indian citizens.
Healthcare Delivery Models and Healthcare Budget
In India, the healthcare and delivery systems include the government, NGOs, doctors, academicians, pharmaceutical companies and health insurers with specific roles. The private health sector has seen substantial growth but the absence of a robust public healthcare system has resulted in debts for almost 40 million people. The WHO framework on the healthcare system includes leadership governance, service delivery, information, financing, health professionals, medical products and technologies. The primary healthcare system in India mostly comprises of Community Health Centres (CHC), Primary Health Centres (PHC) and Sub-Centres. In a survey in rural Bihar conducted in late 2018, only 13 percent of respondents chose cash over public health and nutrition services. This shows that there is a huge financial gap in the provision of healthcare in the country .In the Budget for 2019, it was announced that Rs 61,398 crore had been allocated for the health sector and Ayushman Bharat (universal health insurance scheme) will receive Rs 6,400 crore, in a step towards meeting Universal Healthcare Coverage standards set by the WHO.
PPP Partnerships and Challenges in Implementation
One of the systems that can propel India towards Universal Healthcare Coverage is Public Private Partnership. There are two models wherein the private sector provides financing and the public sector provides services and the opposite where the public sector finances healthcare. If implemented effectively, the PPP model can bring quality and affordable healthcare and expand services offered by public healthcare situations. The stakeholders in the public-private partnerships are the government, healthcare providers, private/civil society organisations, patients and healthcare personnel. They can collectively increase the quality of services and attain the goals of population coverage, financial coverage and service coverage by 2022.
The main healthcare challenge for India is to ensure quality and equitable access while preparing to address the changing disease incidence profiles. A PPP model comes with many challenges like financing mechanism, management to sustain the programme, strategic planning, monitoring and evaluation and educating civil society. Increasing affordability and equitable access to healthcare is a key challenge in the PPP system. Making medicines affordable is important because they consist of 70 percent of the out-of-pocket expenditure on healthcare. Reduced prices and prescription of generic drugs is one of the solutions to this challenge.
Infrastructural development is another area of improvement, and in India, efforts are on to make the infrastructure of district hospitals available to private hospitals to bridge the infrastructure gap. Management and operation of healthcare facilities are crucial to ensure technical efficiency, operational economy, and quality. Standardisation and accreditation is a hurdle too, as all stakeholders must comply by and maintain uniformity with respect to treatment guidelines, patient records, health service costs, etc. The focus must be on Tier II and Tier III facilities to ensure a basic quality of care.
Medical education and continuing education must be accessible to doctors to meet the WHO norm of 2.3 physicians per 1000 persons as India has only about 0.7 physicians per 1000 population. Training and capacity building of professional, para-professional and ancillary staff who deliver healthcare to the public is important too. Voluntary and mandated third-party financing mechanisms must be created to ensure financial inclusion. The establishment of national and regional IT backbones and health data centres for access to clinical data, as well as setting up of a materials supply chain for easy access to serviceable equipment and appliances, medical supplies as and when required is another crucial test for the PPP model. The model can be successful and Universal Healthcare Coverage can be achieved for all by 2022, when the government implements co-ordination of all stakeholders in meeting these healthcare goals.