Let’s have better health cover for all

That India, a country of abundant talent and phenomenal possibilities, should occupy e 101st rank in the 2021 Global Hunger Index of 116 countries is a tragedy of epic proportions. Our neighbours Pakistan, Bangladesh, and Nepal come ahead of us on the hunger index. This merits deep introspection. Excuses that cite the enormity of our geography and population density as a stumbling block don’t work.

As a nation, it is high time we put our hearts and souls together to develop radical solutions ahead of rhetorical assertions. We can no longer condone, under any pretext whatsoever, the rampant child undernourishment, stunted growth, and mortality that pervades the length and breadth of India.

Closely linked to the highly deplorable hunger issue is the sorry state of bottom-of-the-pyramid healthcare which is gasping for breath even after 75 years of independence. Clearly, the root cause is the glaring and growing disparity between the rich and the poor which has only widened over time.

India is a mega nation of disparate regions, from the most developed and newly emerging to the utmost deprived and gradually developing. As a consequence, healthcare quality has been brutally reduced to a cost issue. The well-off continue to avail of the best-in-class treatments while the poor have to bear with inferior procedures that are heavily compromised in every respect.

To make matters worse, the Covid-19 pandemic caused a lethal dent in the delicate healthcare fabric. During its peak, the deprived sections were the worst hit. Scores of patients suffering from non-communicable diseases had to face the consequences of a delayed diagnosis: undesirable outcomes and the ballooning cost of treatment.

Universal health cover has long been a matter of contemplation following expert recommendations. Way back in 1946, the Joseph Bhore Committee Report underlined the criticality of a model ensuring adequate healthcare for all individuals, including those who can’t afford it. For something to have been thought of even before our independence, it is baffling that we don’t have a universal healthcare model even in this tech-driven era.

This is not to question the government’s intent which has always been about the right things; but it has not necessarily been about the right ways. Take the case of the Ayushman Bharat scheme. It is designed to cater to patients below the poverty line but given the negligible amount it extends, optimal quality care becomes next to impossible. We must hence detach the quality of care from the clutches of financial constraints through universal health coverage. India is primarily a nation of youth who are aggressive cell phone users.

Why can’t we impose a small tax on every such user and create a huge corpus of universal health? This cover will ensure uniformity of treatment for the vulnerable population, devoid of the burden of financial strain and debt traps. The charm of this levy is that the contributors could also be the beneficiaries, as they can avail of health services with advancing age or ailment.

Talking of the broader healthcare system, policymakers should collaborate with visionary health practitioners to fine-tune it. ‘For profit’ and ‘Not for Profit’ can’t be watertight compartments in healthcare; a prudent system must ensure that the affluent pay for value-added care, while the poor avail of free or subsidised rates in line with their wherewithal. Price tags should vary, not the quality. When disease does not know rich or poor, why should the treatment make a distinction?

In parallel, the government should proactively help private hospitals with more liquidity and fresh capital. It should also increase GDP allocation to healthcare, as also provide tangible relief to healthcare entrepreneurs in the form of GST write-offs, tax incentives, and a moratorium on payments. Private healthcare provides 75 to 80% of healthcare in India. If the small and mid-sized hospitals collapse due to lack of capital, government hospitals would be in no position to cater to all the patients.

India urgently needs a value-based healthcare model to democratise health care delivery, led by improved accessibility and affordability with no compromise on the quality front. For Indian healthcare to move up the value chain, cost consciousness and quality consciousness must co-exist. Healthcare enhancement, like hunger eradication, must become our top priority, ahead of space missions and smart city development.

(The writer is the executive chairman of a cancer hospital chain.)

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