On the heels of its landslide electoral victory, the government has taken the bold step of changing the narrative of development. In fact, it has shown that it is prioritizing critical social and development issues by releasing the much-awaited health policy draft. The fact is it is doing the right thing: it is not focusing on near-term electoral gains and is positioning health as a national priority by backing it with greater spending.
The proposed blueprint is targeted, sensible and comprehensive. Significantly, the policy takes a holistic view of the health system and achieving better outcomes across elements of access, cost and quality—all closely inter-related. The policy looks to increase access to care by expanding coverage to the underprivileged and under-served and focuses on primary healthcare packages with geriatric, palliative and rehabilitative services. It also looks at increasing hospital beds to 2 per 1,000 people from an appalling 1.3 in 2012. Importantly, there is a commitment to increasing the public spending on healthcare to 2.5% of gross domestic product (GDP) to help finance these initiatives.
The health policy has also sensibly focused on being cost-effective by focusing on preventive and promotive care and trying to fundamentally change the paradigm from sickness to wellness. This is the need of the hour as its cost effectively improves outcomes. In fact, early intervention reduces costs by 10-20x vis-a-vis late treatment in the case of diabetes and leads to 85% reduced costs and a 2x increase in survival rates for cardiovascular diseases. Useful lessons can also be learnt from countries such as Singapore which have delivered world-class outcomes by spending among the lowest levels on healthcare (around 4.5-5% of GDP). Other health systems show that a focus on primary care reduces the mortality and morbidity of cancer and cardiovascular diseases by a good 20-50%.
It is also great to see the focus on outcomes such as life expectancy and disease-specific targets. Worryingly, we have missed achieving millennium development goals in infant and maternal mortality. And, if we don’t address the epidemic of non-communicable diseases, our growth potential will be gravely undermined.
The policy also focuses on quality, recognizes the role of the private sector and envisages the creation of a public health management cadre to optimize health outcomes. Talent is a constraint at multiple levels and acceleration of capacity is critical to driving access, which the emphasis on affordability alone will not solve.
In covering the “what" of the health policy, there are crucial grey areas that require clarification. A critical one is the shape of universal health coverage, which is the bedrock of higher access to healthcare. There are many competing models for achieving the desired objectives and the way forward needs a clearer articulation.
Some critical factors to ensure healthcare delivery to all:
The issue is how the private sector can engage with the government to create a sustainable model for health and financial outcomes, since government health infrastructure has not delivered. This is especially important, given that nearly 80% of the current infrastructure is private-driven.
Today, we are significantly under-consuming wellness: Even in urban India the average number of outpatient/inpatient visits is 10 vs 69 in the US. We need to encourage a behavioural shift towards consumer wellness. An abundance of linkages across primary and secondary care, information sharing, alignment of incentives across the private and public sectors and different healthcare sub-sectors needs to be brought about.
The government needs to establish levers to enable increased financing for healthcare as well as a mechanism to allocate additional funds across centre and states as also among different competing healthcare needs.
There is also a need to move towards a more capitated model which limits costs and improves outcomes by bringing in proven concepts like moving away from “fee for service" to “paying for performance". Besides, a mechanism to procure products and services from the private sector in an optimal manner that balances efficiency with quality is required.
A big issue is balanced access to technology with the need for higher affordability. How will levers such as price controls be used in the future, or will we move to mechanisms like health technology assessments?
We will have to accelerate the quality grading of establishments—something that is at abysmally low levels today. Also, how do we enable a non-linear scale-up of capabilities across the system—doctors, nurses, primary care infrastructure, district hospital infrastructure—all of which are woefully inadequate?
Finally, it would have to encourage digital usage to bring about the vision of an Aarogya Bharat and it would be interesting to see the role of the National eHealth Authority.
Let’s applaud the government on its thinking and come together to help usher in a new and more sustainable paradigm for healthcare for Aarogya India that will benefit us all.
Karan Singh is the managing director of Bain & Company India and a former co-lead of the firm’s Asia-Pacific healthcare practice. Parijat Ghosh is a partner with Bain & Company in New Delhi and leads the India healthcare practice.