Way back in 1884, Otto von Bismarck, the first Chancellor of the German Empire, succinctly captured the issue of what access deficit to healthcare does while talking about the need for social welfare. He said, “…the actual complaint of the worker is the insecurity of his existence; he is unsure if he will always have work, he is unsure if he will always be healthy and he can predict that he will reach old age and be unable to work. If he falls into poverty, and be that only through prolonged illness, he will find himself totally helpless being on his own, and society currently does not accept any responsibility towards him beyond the usual provisions for the poor, even if he has been working all the time ever so diligently and faithfully. The ordinary provisions for the poor, however, leaves a lot to be desired ...”
Ever since, this has remained the dominant theme of social welfare in state affairs. With India growing rapidly as never before bridging the gap between the demand for healthcare and the supply of healthcare services, that too at an affordable cost, is increasingly becoming crucially important. The problem becomes crucial if we look at the distribution of doctors on the basis of their distribution over urban and rural areas. It’s said that patient doctor ration in India is around what it ought to be. If that be the case, what is the issue? The statistics says, 74 per cent of the doctors are serving urban and semi-urban areas covering a population of less than 442 million people. At the top of that there are studies indicating even among those serving the rural healthcare facilities the incidence of absenteeism is rampant making availability of healthcare in the rural areas more dire than what the data tend to indicate.
This issue instantly captures the skewed distribution of healthcare facilities in India. Even though healthcare industry, by an estimate made by KPMG, is poised to grow at a CAGR of over 20 per cent, it will hardly ever touch the life of the majority of the people, namely the rural folks, in India. The reason is not difficult to guess. The industry grows towards the market where the profit is. With the rural belt being what it is, i.e. a cauldron of poverty of various hues, it lacks the attraction for the traditional private healthcare industry. This is the reason the government globally has a compulsion to step in to correct the skewness in the distribution of healthcare distribution.
However, for all countries it’s a huge task. Even those countries which are models of state healthcare like the UK, the burden of funding the system is becoming unbearable. If that happens with the UK, it’s easily understandable the pressure that India faces in this regard. It acts as a double edged sword and cuts both ways. If a comprehensive coverage is provided by the state, the cost would make other developmental expenditure unaffordable. On the other hand, if the challenge is not met, development will suffer from lost person-days leading to greater poverty incidence and at the end national prosperity goals will be undermined.
Strategically speaking, the solution lies in wiping off out of pocket healthcare expenditure need of the poor. Due to lack of social support poor meet their healthcare needs on as and when basis and that too from paying cash generally referred to as the ‘out of pocket’ payments. When meeting both ends is an issue, one can well imagine its impact on the poor. This challenge can only be met either by providing free healthcare, which is a burden on the exchequer, or creating subsidised comprehensive health insurance for the poor to take care of their healthcare needs. Later, obviously has comparatively a lower burden on the coffer.
The Ayushman Bharat scheme has precisely this goal in mind by providing family health insurance cover of Rs 5 lakh. This is a substantial coverage amount and, properly implemented, would take care of almost all purse draining medical needs. Further, given the following key words in the healthcare need, namely preventive, curative, rehabilitative and equity along with a pre-paid system, Ayushman Bharat is expected to take care of the bulk of the issues. The cost of this programme would be shared by Centre and states in 60:40 ratio, for the North-East, however, the ratio would be 90:10.
For the preventive healthcare silo, the government has launched Mission Indradhanush to take care of the immunisation in a comprehensive way. The issue of accessibility, however, remains to be addressed. With healthcare being a State Subject the country would need an involved, all-out, unanimous dedication in evolving an easily implementable model for creating a universal, equitable access to healthcare. Once that happens, development efforts will not wilt under the burden of illness.