THE GIST of Editorial for UPSC Exams : 09 APRIL 2019 (Healthcare system hanging on hospital insurance without foundation of primary care is unsustainable)

Healthcare system hanging on hospital insurance without foundation of primary care is unsustainable

• The forthcoming election is going to be an inflexion point for India’s health system story how affordable, how accessible, how equal?
• In the US, it is individual liberty and personal responsibility, while Europe and countries like Japan are driven by ideas of social responsibility and state accountability.
• The emergence of these two ideological streams had their origins in the rise of Marxism in early 19th century and World War II that devastated UK’s economy, to declare that
  “Individuals should recognise the duty to be well and restoration of the sick person to health is a duty of the state and the sick person.
  With its strong belief in individual liberty, the US confines itself to subsidised care for the poor and elderly, regulates stringently for quality and allows financial incentives like profits
  to encourage technological innovation.
• As a consequence, it has over 20 million of its population without access, despite spending 18 per cent of its GDP on health.
• The UK and Europe, on the other hand, believe in the principle of collective responsibility ensuring every individual’s inherent right to health and wellbeing.
• These countries spend an average of 10 per cent of the GDP on health with far better outcomes than the US.
• When India won independence it is driven by the European values of equality.
• The right to vote to economic and social models trended more along the values of individual liberty rather than social equality.
• Disparities of 1 per cent of India’s population enjoys 70 per cent of its wealth.
• While an Indian is among the 10 richest of the world, we also account for the world’s poorest, over 36 per cent of children stunted due to chronic malnutrition, half of the population defecating in the open and nearly three-quarters without access to tap water
• The rising burden of disease in India is but a reflection of such deprivation of essential and basic social goods and the wide inequalities cutting across regions, castes, gender and age.
• To understand why India is a sick country why huge disease burden such wide inequities in accessing medical treatment broken and dysfunctional system of healthcare, spend only about 1 per cent of its GDP on health, one needs to understand the values that drive our social, economic and political development.
• The lobbies have the support of US-based foundations and donors, World Bank, CII, FICCI, the medical associations and companies related to health insurance, data aggregating IT, medical devices etc.
• Comprehensive primary care numbed out.
• No one would argue that hospital insurance is a wrong policy and that only primary care should be the focus.
• But a system hanging on hospitals without the foundation of primary care is a sure recipe for disaster as it is clearly unaffordable and unsustainable.
• With the revision of hospital rates, the cost of the health insurance programme will also double and continue to rise.
• Its absence is responsible for the proportionately higher number of premature deaths, one quarter of the global TB burden and a million dying just for want of clean air.

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