It’s high time India chalks out a plan to provide healthcare to all its citizens, irrespective of their economic status. Other countries are working toward it and have already moved passed us. If the scenario has to improve, we must start acting now. Sadly, the government is neglecting its responsibility. This needs to change. Here’s where to start.

National health cover to address access and affordability issues for ensuring universal healthcare is an idea whose time has come in India. Of late, for compelling reasons, including the comparisons with nations that have moved passed us in this respect, sporadic efforts to improve healthcare infrastructure are being made by the government and private organisations working in the field of healthcare.

At a global level, through intervention by organisations like World Health Organisation and at the national level, there have been moves to provide better healthcare to more people. Unfortunately, most of the improvements have been in the private sector, whose facilities are unaffordable to a large section of the population.

Despite the priority to universal health coverage given by the Planning Commission, the government’s responsibility to ensure minimum healthcare along with other basic needs has been getting diluted in the recent past.

The Kolkata Declaration (February 2010) by the Kolkata Group, presided by Amartya Sen and attended by 45 social scientists, policy makers and development experts must have been an eye-opener for authorities responsible for converting constitutional guarantees on human rights into public services. In the changed context of economic development, public and private funds need to be pooled in to make medical facilities, including preventive healthcare, available to every citizen, irrespective of economic status. Costs should be recovered from those who can afford to pay, but cost should not stand in the way of a citizen’s access to essential services, especially emergency medical attention, whether the facility is public or private.

For ensuring that such efforts do not suffer for want of finance, the Government of India should earmark a portion of the windfall gains such as from spectrum/ natural resources auctions and divestments it is appropriating to the Consolidated Fund of India for providing basic necessities to the underprivileged. The government should not shy away from subsidising costs for providing universal public healthcare for the poor. Mere increase in expenditure on healthcare as a percentage to GDP does not indicate any increase in outreach to the needy, as the bulk of the funds are likely to be cornered by big hospitals in cities or appropriated by insurance or pharmaceutical companies under various heads. For achieving the desired result, a top-to-bottom overhaul of the healthcare infrastructure and funding modalities may have to be taken up.

Sometime ago, there was a report about the efforts of Manipal Health Enterprises to dispense with the comprehensive primary and polyclinic-style preventive and curative wellness services in residential areas, and bring back the dying family physician mode. This is worth emulating nation-wide by the medical profession and service providers in the area of healthcare. The model of the National Health Service (NHS) in UK, which takes care of the healthcare needs of each citizen by linking them to general practitioners (GPs) and good hospital facilities, may be a distant dream for a country like ours, though, with a population over 1.2 billion and limited resources being allocated to healthcare.

Still, linking the healthcare needs of each family to a local doctor, primary health centre, private hospital or at least a health inspector from the state government health department would create more health awareness, improve preventive healthcare and reduce delay in diagnosis of cases where quick medical attention would minimise the chances of complications.

As the benefit of health insurance and the option to avail of medical facilities in the private sector is presently the privilege of a miniscule percentage of the population, who either work in the organised sector or are in the above poverty line category, such an effort is necessary to increase the outreach of healthcare. Here, coordinating various commercial ventures in health services and government efforts from a social responsibility angle would be necessary. Perhaps, an initiative in this direction could be taken by local chapters of the Indian Medical Association and respective state government health departments. The UK NHS model could be a distant goal.
 

There are many arrangements under which general practitioners can work in the UK. While the aim of a UK doctor is to become a principal or partner in a GP surgery, many become salaried or non-principal GPs, work in hospitals in GP-led acute care units, or perform locum work. Whichever role they fill, the vast majority of GPs receive most of their income from the NHS. Principals and partners in GP surgeries are self-employed, but they have contractual arrangements with the NHS which brings stability to their income. Visits to GP surgeries are free in the UK, but most adults of working age who are not on benefits have to pay a standard charge for prescription—only medicine. GPs in the UK may operate in community health centres.
 

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Till such time systems are put in place, we should take extra care to ensure adequate funds for treatment and insurance. Serious thought should be given to post-retirement medical insurance cover sufficiently in advance, as “running for cover” after retirement can be frustrating!
 

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(MG Warrier is a freelancer based in Mumbai.)