Reforms needed to strengthen India’s healthcare system
According to the Economic Survey 2022-23, India’s per capita health expenditure is Rs 4,470, of which the out-of-pocket expenditure is around 47 per cent. For affordable and quality healthcare, a larger policy is needed, touching across several sub-sectors such as health insurance, medical education and capacity-building.
One health insurance scheme for all
This will tackle several significant challenges. One, the presence of multiple schemes can lead to fragmented coverage, where some individuals may be covered under state schemes, while others being covered under Ayushman Bharat. This creates confusion and inefficiencies. Two, the coverage provided by state schemes may vary significantly, leading to inequitable access. For instance, some states may have more comprehensive coverage than others. Finally, managing multiple schemes can lead to administrative overheads, the need for separate databases, claim processing systems and monitoring mechanisms. This diverts resources away from healthcare delivery.
Forming a Health Council, akin to the GST Council, can ensure this transition is federally-aligned and incorporates diverse stakeholder perspectives. Further, the ownership and accountability should be brought to the doorstep of state governments, giving them a greater stake in its successful implementation and management. This can also help address regional disparities in healthcare.
Additionally, the process of claiming insurance needs to be streamlined. Insurance providers, both public and private, should be mandated to use standardised, easy-to-understand policy documents. The inclusion of essential consumables like medicines and diagnostics can go a long way in making healthcare more affordable.
Minimal cess on premium products to create a corpus for healthcare
To boost investments, the government should consider imposing a cess or surcharge on premium products like health insurance, flight tickets and train tickets. This nominal sum, which could be deductible from income tax, would create a dedicated corpus that can be reinvested to strengthen primary healthcare facilities. Such financing mechanisms can help address the underinvestment in the public health system. The government should also explore public-private partnership models to leverage private sector expertise and resources.
Standard practices and knowledge-sharing
Ensuring consistent quality of care across the country is another crucial reform area. Premier government medical institutions like AIIMS should develop standard operating procedures (SOPs) for managing chronic diseases. These SOPs, then, must be replicated across the network of government hospitals. Standardisation, combined with better coordination, can go a long way in improving patient experiences and health outcomes.
Revisiting medical education
The medical education system in India faces several challenges. The government should undertake a comprehensive review of the entire process, leveraging technology and AI to make it more reliable and affordable. This can include measures like online applications, computer-based testing, and real-time monitoring to eliminate last-minute exam cancellations and the resulting wastage of public resources.
Other reforms
To further improve the doctor-population ratio, specifically in rural areas, the government should incentivise newly graduated doctors to serve in underserved regions for a minimum of five years. During this period, they can also be provided opportunities to pursue postgraduate studies. Additionally, MBBS graduates could be offered specialised diploma training programmes to equip them with the necessary skills for emergency services.
A centralised database of doctors is also required. This would help in better resource mapping and management. According to government estimates, there are currently over 1.5 million practicing doctors in India registered with the National Medical Commission. A centralised database could be used to optimise the deployment of these professionals.
All district-level government hospitals should be well-connected, especially in terms of digital linkages, to facilitate the sharing of best practices, clinical protocols and innovative solutions. Regular seminars and symposiums can foster a culture of knowledge exchange.
The affordability of medicines is another critical aspect. The government must focus on bolstering the domestic production of pharmaceutical raw materials. Providing R&D grants to companies can also incentivise the development of cost-effective drugs. Additionally, the government should explore price control mechanisms and bulk procurement strategies to ensure that essential medicines remain accessible and affordable.
These reforms, if implemented, can pave the way for a more equitable, accessible, and efficient healthcare system in India.
Sumeet Bhasin
Director, Public Policy Research Centre
Posts on X: @sumeetbhasin