A developed country must have a robust healthcare system

THE country has set itself the goal of becoming ‘Viksit Bharat’ or ‘Developed India’ by 2047, when it will complete 100 years of Independence. By then, it is projected to become a $35-trillion economy, which will be the second largest in the world, behind only the US, after overtaking China, Germany and Japan. But to get there, it will have to grow by 9-10 per cent every year for around three decades from the present 7 per cent plus, which has already made it the fastest growing large economy in the world. If we set aside for a moment the thought that such talk is just pre-election rhetoric, it becomes incumbent upon those who put together scenarios to show a pathway which will explain where such consistent super-high growth will come from.

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One, but not the only way in which this goal can be facilitated is by transforming the healthcare sector, in which India currently fares poorly by global standards. This is all the more necessary as a developed country must necessarily have a developed healthcare system. The Legatum Institute, a London-based think tank, has sought to evaluate and rank healthcare systems across the world based on their citizens’ ability to access healthcare in order to remain in good health. As is to be expected, Singapore is ranked number one, followed by Japan, South Korea, Taiwan and China (in that order). India (112th) does not figure in the top 100; Sri Lanka (47th) is even ahead of the US (69th)! Thankfully, India is also not on the list of 10 countries with the worst healthcare systems in the world.

India’s healthcare expenditure improved from 1.6 per cent of GDP in 2021-22 to 2.1 per cent in the last financial year (2022-23). But even at this level, it remained the lowest among BRICS countries, according to World Bank figures (for 2019). India’s expenditure then at 3 per cent of the GDP was less than that of Sri Lanka (4.1 per cent) and China (5.3 per cent), not to speak of Brazil (9.6 per cent) and Japan (10.7 per cent). Only Bangladesh (2.5 per cent) was behind.

Thankfully, there seems to be some official realisation that the state needs to do more on healthcare and the Interim Budget has provided for a respectable 14 per cent rise over the previous year in healthcare expenditure to Rs 90,000 crore. But this will not affect the share of healthcare in the GDP as that also will go up by around 11 per cent nominally, given the retail inflation of around 4 per cent. However, there is another plus. The pharmaceutical sector, which has made India the global pharmacy that delivers cheap and affordable medicines, has been allocated Rs 1,300 crore for development expenditure when virtually none had been allocated earlier.

There is also one other positive trend. Out-of-pocket health expenditure, which often drives the poor to destitution, has gone down from a peak of 69 per cent in 2013 to 51 per cent in 2020, according to World Bank data.

What do all these numbers tell us? India has miles to go in improving its healthcare system if it seeks to become a developed country. That will be impossible if emerging new generations are not healthy and skilled so as to be able to add substantial value as members of the workforce.

A key initiative of the government in taking forward healthcare so that it can serve the poor is the Prime Minister’s Ayushman Bharat Jan Arogya Yojana (PM-JAY), launched in 2018. It offers free access to health insurance for the bottom half of the population. It provides free secondary and tertiary care of Rs 5 lakh cover per year per family, which will be available in empanelled public and private hospitals. Also, far better primary care will be sought to be provided by upgrading 1.5 lakh primary health centres and sub-centres into health and wellness centres, each of which will have a medical officer, a nurse, a pharmacist and a lab technician.

The Interim Budget has brought ASHA workers, who visit poor families at their homes for vaccination and maternity-related care, and anganwadi workers, who take care of and feed pre-school children, under the PM-JAY scheme. The government will also launch a vaccination management platform, U-Vin, which will help achieve 90 per cent full immunisation. Further, it will encourage vaccination against cervical cancer among girls in the 9-14 age group.

The Budget has also announced a key step to expand access to tertiary care. It will help set up medical colleges by using the existing tertiary care hospital infrastructure. District hospitals have already started to move forward in setting up medical colleges on their premises. A medical college means increased round-the-clock availability of trainee doctors and nurses.

A lot of the above are plans on paper. What is the ground reality? For secondary and tertiary care to be available to a poor family, it should be able to take an ailing member to the nearest empanelled hospital, public or private, where care can be provided without payment under a cashless facility. Official sources readily hand out statistics to establish that the scheme is working well, but anecdotal evidence suggests that there are glitches galore.

To make things easy for the privately insured, the state-owned General Insurance Corporation of India has launched a plan under which policyholders can get treated in any hospital under the cashless hospitalisation facility. Even if the hospital is not part of the network for the insurer, it will settle the bill at the hospital, making it possible for policy holders to get cashless treatment. But the Hospital Board of India of the Indian Medical Association has urged health hubs not to get into ‘cashless everywhere’ agreements with insurance firms or third party administrators (TPA) as such arrangements would affect the finances of hospitals, with securing reimbursement under insurance policies being a tortuous affair.

Healthcare for all, without which a country cannot achieve developed status, is a long way off. All that we can say is a beginning has been made, but the reality is that public hospitals are overcrowded and the ‘private hospital and health insurance’ route works out to getting a patient admitted with a hefty deposit and them haggling with the TPA to get the final bill cleared, with a whole lot of expenses charged by a hospital being disallowed.