by,Krishna Reddy , Country Director of ACCESS Health India…
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At the time of India’s independence, people’s health needs were mostly met by public facilities and few non-profit faith-based and philanthropic facilities. As successive governments neglected healthcare, under resourced and poorly managed public facilities were insufficient to meet needs of growing population and increasing disease burden. Private healthcare started filling in to the vacuum being created due to perpetual neglect. It started with general practioners (GPs), growing into small to medium sized nursing homes. Advent of corporate hospitals started in late 1980s, beginning with Apollo Hospitals. Growth extended into private diagnostics and pharmacies. Recent years are witnessing growth of online and at home services.
While growth of private sector provided an alternate access to people, successive governments again failed in providing effective stewardship over private sector, leading to emergence of highly fragmented and unregulated private sector. As costs started climbing up in private sector, catastrophic health expenses became the leading cause of pushing people into poverty. With increasing investments from private investors, corporate culture overtook the very purpose of medicine. To maximize returns on short-term investments, managements started resorting aggressive marketing and medical practices leading to unethical practices driving up the costs further. Fee per service payment systems resulted in overuse of many diagnostic and treatment plans, both by hospitals and medical professionals. The net result is that growing number of people are fast losing trust in private healthcare system as well. Ongoing Covid pandemic exposed these gaps in both public and private healthcare systems for vivid public view. It is in this context that there is an urgent need and a golden opportunity to restore trust in public healthcare system.
Recently enacted National Health Policy (NHP-17) commits to increase in public health spending to 2.5% of GDP from the measly spending of 1.2% of GDP at present. Resources can be mobilized on priority to fast track the commitment. It is estimated that 20 to 40% of budgeted expenditure remains unspent across States due to inefficient public health finance management. Bringing in professional approaches to finance management can unlock these unspent funds for better use.
India is persisting with line-item budgeting since independence. Budgeted financial resources are not in alignment with healthcare needs of a given population. In addition, there are many vertical central and state-level programs with their own separate budgets. Hence, there is a scope to improve financial management by shifting towards population health risk based global budgets along with integrated delivery networks.
With a mission to achieve universal health coverage (UHC) by 2030, India has launched its most ambitious Ayushman Bharat program, which consists of repurposing existing sub-centers (SC) and primary health centers (PHC) into 150,000 health & wellness clinics to strengthen primary healthcare services across the country and Pradhan Mantri