Unequal Access to Healthcare

What is the issue?

While India boasts of having an ultra modern healthcare infrastructure, the masses in India actually aren’t even able to afford even basic medical facilities.
Our policymakers have shown no real zeal to provide equitable medical care to all citizens cutting across classes.

What is India’s vision in the health sector?

The NITI Aayog’s 3 year vision document has recommended the government to prioritise preventive care rather than provide curative care.
The document has advised the government to focus on the public health as whole and not merely restrict itself to “health care” and hospitals sector.
Further, it asks the government to better public health infrastructure to cater to the needy who can’t afford private care.
Notably, out-of-pocket expenses for medical care are about 70% of all medical expenditure in India currently.
While the vision statement spelt out seems ambitious, India’s previous track record in health care has resulted in serious scepticism.

How entrenched is class based exclusiveness in our health care sector?

Divide - It is a hard reality that not all medical interventions are available to every citizen who may need it due shortage of infrastructure and funds.
The major technological leaps in medicine starting from 1980s have only widened the gap between the private sector and the government hospitals.

Failures - Every government since Independence has stated egalitarianism as its goal in health care, but the reality has been rather different.
Many interventions, especially those which are very expensive, continue to be accessible only to those who can pay for them.
Notably, costly interventions are provided in a few government hospitals, but these are merely tokenism, and an attempt by governments to appear fair.
Recently - Even the new “Ayushman Bharat Health Scheme” which covers a whopping 40% of India’s population seems patchy on this count.
Notably, the scheme seeks to provide secondary and tertiary care to the economically deprived class, but has a cap of Rs. 5 lakh per family per year.
While the beneficiaries can access both private and public hospitals for treatment within that limit, it is unlikely help them access costly treatments.
Notably, there are indications that an explicit “negative list” for procedures which will not be covered under the scheme, will be pronounced.

What are the other flaws in India’s health policy?

Subsidy - In order to promote investments in health, governments have been giving subsidies to private players in health sector.
Notably, it is these subsidies that have aided these private hospitals to cater to foreign clients at rates far cheaper than the western world.
As subsidies in a way are taxpayer’s money, it is a clear case of taking from the poor to give to the rich private corporate hospitals.
Corporatisation - Private hospital chains in India have entered every segment of medical care including complex tertiary care, and diagnostics.
Most have large investors from abroad and some are effectively controlled by foreign investors, all of whom benefit from the government subsidies.
Privatisation - Successive governments have been increasingly dependent on the private sector to deliver health care to the masses.
The new “Ayushman Bharat Scheme” would only further this dependence and hospital chains are sure to see a significant spike in their profits.

What is the state of our public health institutions?

As health care is indeed costly and out of reach for most citizens, public hospitals continue to be the only resort for the masses.
Successive government policies over the year have been favouring private health players over the public sector due to various constrains.
Public health sector has been largely under-funded, under-equipped and under-staffed, and its quality and credibility eroded over time.
Consequently, even the morale of the doctors and staff in public hospitals has taken a severe beating in comparison to their private sector peers.
If public hospitals are to be bettered, coordinated and sustained action is needed on the part of the government, which currently seems lacking.

Source: The Hindu