Launch of FDR’s Publication - 'Towards Viable Universal Healthcare'

The Covid-19 pandemic has rightly turned public attention to healthcare delivery in the country. However, it must be recognised that our healthcare crisis is not one of recent origin. The policy failings predate the pandemic and the prolonged neglect of the healthcare system has worsened healthcare challenges over time. Public expenditure on healthcare has remained low at around 1.2% of the GDP. Similarly, patronage for public health facilities has been sub-par at 25% of all doctor consultations which means that majority of healthcare services are being availed in private facilities at much higher costs. There is no coordination across the three levels of care - primary, secondary, and tertiary - resulting in the overburdening of the secondary and tertiary care hospitals. Further, India’s population is undergoing an epidemiological shift with a rise in non-communicable diseases like diabetes, high blood pressure, heart disease, lung disease etc. This on the one hand adds to the burden of an already strained system and on the other hand, further increases healthcare expenditure. Consequently, about six crore Indians descend into poverty every year due to lack of access to quality and affordable healthcare services. In the two Telugu states alone about 50 lakh people are descending into poverty every year on account of ill health.

There is an urgent need to design a coordinated and comprehensive healthcare system taking into consideration current and future requirements. Fortunately, India can claim several strengths in the healthcare sector. We train a large number of healthcare professionals and are self-sufficient in human resources. After China, India has the highest annual inflow of qualified doctors. In addition, the cost of most healthcare interventions, including the most complex medical and surgical interventions, is among the lowest in the world. Similarly, the Indian pharmaceutical industry is highly efficient and economical, ensuring adequate drug supply at a low cost. Therefore, an effective healthcare system that provides quality healthcare at a low cost can be built by leveraging these strengths.

The proposed model in the publication titled ‘Towards Viable Universal Healthcare’ is a modest attempt to ensure effective, accessible, and affordable healthcare services for all. The model seeks to build on existing infrastructure, institutions and programmes with least dislocation. It leverages our considerable strengths in the health sector, and builds on successful best practices. Being flexible and pragmatic, it can be seamlessly adapted to suit varying conditions across states. It is an eminently sustainable framework that seeks to ultimately reduce the disease burden in a cost-effective manner for the state as well as the people.

The key elements of this model are: continuum of care through a publicly-funded Family Physician-led primary care system with choice and competition for all outpatient care; limiting secondary and tertiary level hospital services to inpatient care, upon referral; expanding the scope of Ayushman Bharat (and other public-funded single-payer health insurance/assurance schemes) to cover all secondary care procedures for all citizens, whilst removing tertiary care services from its coverage; and making district and public teaching hospitals the mainstay for quality, cost-effective tertiary care in the country. While the public exchequer will largely bear the cost of operationalising this model, private players will play a key role in delivering services, ensuring efficiency as well as cost-effectiveness. It envisages public-private-partnerships and innovative modes of financing. 

The additional cost of implementation of this model will be about Rs. 85,000 crores per year across the country - about 0.4% of the GDP. Even with this additional expenditure, the total government expenditure of the country will be only 1.6%, the lowest among all major countries. In Telangana and Andhra Pradesh, the additional cost will be about Rs. 1900 crores and Rs. 2600 crores respectively. 

The proposed model, if implemented, will build a robust, viable, affordable, universal healthcare system in India. A holistic restructuring of the healthcare system is critical in transforming the health sector and improving the lives of hundreds of millions of our people. In an effort to advocate for these reforms, the Foundation for Democratic Reforms (FDR) is reaching out to all stakeholders - the Prime Minister, Union Ministers, Niti Aayog, Economic Advisory Council, Members of Parliament, the media and several of the organisations and individuals working in this field. With healthcare being a state subject, reform ultimately would have to begin from the states. Therefore, FDR has sent the publication to the Chief Ministers, Health Ministers, and the bureaucrats concerned of all the states in the country. Additionally, FDR intends to personally call upon various states to persuade the governments to implement these reforms, beginning with Telangana, Andhra Pradesh, Tamil Nadu, Karnataka, Kerala, Maharashtra and Odisha.