Merely health insurance can’t cut it when basic infrastructure is in a shambles

As reported by this paper on Tuesday, the government is considering bringing a comprehensive universal health insurance scheme that will cover vulnerable sections of society and workers from the unorganised sector. The premium would be subsidised by the government depending on the income of the individual concerned. Given the fact that for decades healthcare has not received the attention it deserves from successive governments at the centre, any step which increases the probability of helping billions of Indian get access to reasonable quality of health care can only be welcomed. But for the proposed scheme to make a real difference to the intended beneficiaries, just providing health insurance policy would not suffice, it needs much more than that. Our policy makers need to have a look at all aspects of the healthcare in India. Otherwise, this insurance scheme would become like many others that are present in government files and slogans.

The government needs to improve the existing state-owned healthcare infrastructure. In case of the private sector, it should act as enabler so that the private sector is able to expand at a fast pace. The fact that the government is looking at insurance as a tool for providing healthcare clearly indicates that it is looking towards the private sector to play an important role — that is the interference drawn from the insurance scheme, that it would be used to treat patients in privately-owned hospitals.

Coming to the state-owned segment, it is worth noting that health is also a state government subject. It is this overlapping in areas pertaining to work and jurisdiction that has caused healthcare to end up being nobody’s baby. A mechanism needs to be evolved where the central government takes care of two aspects: first, the broad framework of the law, and, second, financial assistance to state governments to improve healthcare. State governments should be asked to implement multiple healthcare infrastructure projects for which money should come from the centre. Now while being implemented by states, the running of this project should be done as per certain standards, which are laid by central government, and their running should also come under certain amount of regulatory sight of central government.

This is important so that states don’t become lax after getting the money and ensure that services at the health centres and hospitals are of a high standard at all times and not just at the beginning, after the facilities are established. The running cost should be largely borne by the central government so that states are not able to give the excuse of lack of funds. The reason why improving the state-owned and run healthcare system is more important than giving insurance policies is the fact that private sector healthcare cannot and will not go to all the areas where there is a maximum need of health care facilities.

One area, which our policymakers need to look at, is the primary problem of supply side constraints, essentially, lack of trained doctors. A part of the resources should be marked for increasing the number of seats for postgraduate courses in medical colleges. While private sector colleges have been able to bridge the minuscule gap as far as bachelor-level medical education is concerned, they are not able to cover any ground for higher medical education.

Given the fact that putting up new colleges will take time and also more resources, the government should consider giving financial and other technical assistance even to private sector players so that they are able to bridge the gap at the post graduate level of medical education. There is unutilised capacity in the private sector medical education, which, if properly used, can make a reasonable difference to the supply side constraints. The third and most important aspect is the remuneration of doctors in state-owned medical facilities. Today, primary healthcare centres, which were supposed to form the backbone of the healthcare system in our country, are in a shambles. One major factor responsible for this is the lack of proper remuneration to qualified doctors at state-owned hospitals. It is essential to make remuneration at these state-owned centres attractive enough to attract the best talent, or at least give them the choice of working in a government hospital. The only way to improve the health of the Indian healthcare system is to think of a radical treatment otherwise it will remain in state of coma.