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Experts optimistic on healthcare for all in nation

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Mail Today New Delhi, Wednesday, Jauary 12.01.2011

Experts optimistic on healthcare for all in nation
By Dinesh C. Sharma in New Delhi
Given the poor state of India’s healthcare, a universal system that ensures cash-free and accessible healthcare for all in another 10 years may almost sound like a dream. But a group of public health leaders put together by medical journal The Lancet feels this is possible and has proposed a blueprint to achieve this ambitious goal.
At present, the Indian system is one of the most fragmented and co­mmercialised systems in the world. The government spends less than one per cent of the GDP on health.
A bulk of the health-related expendi­ture — 78 per cent — is spent by the peo­ple themselves. This is one of the highest rates of out-of-pocket expenditure on health in the world. The money spent on healthcare is pushing 39 million Indians below the poverty line every year.
"Yes, the goal of a universal healthcare system is ambitious but achievable," Dr K. Srinath Reddy, who led the team of experts, said. "One of the reasons (for this optimism) is the increase in the gov­ernment's capacity to finance such a plan, created by the unprecedented eco­nomic growth." The plan has been elabo­rated in a series of papers published in Lancet, and discussed at a meeting of health experts in the Capital on Tuesday.
The recommendations have also been presented to Prime Minister Manmohan Singh. "Political will is cru­cial- Politicians must realise that health is an essential pre-requisite for transforming economic growth into a meaningful outcome," Dr Richard Horton, editor, The Lancet, said.
 The plan comes at a time when the gov­ernment has also shown some concern over the state of health in the country. A high-level expert group on universal health coverage is currently working on a set of recommendations for the next five year plan. The WHO has also recently emphasised the need for universal care.
A twin strategy of increasing govern­ment spending on health from one per cent of the GDP to six per cent, and the gradual decline in out-of-pocket expen­diture to 20 per cent has been proposed by the Lancet group. It says an inte­grated national health system should be developed to provide free healthcare at the point of use. It should be financed through sources other than out-of-pocket costs. An insurance fund should be set up with financing from the public, employer and private sources. "The existing private sector can be integrated in such a system provided there is a strong regulatory system to ensure quality,cost &pat6ients rights” Dr. Reddy said
Dr Binayak Sen, the jailed doctor and civil rights activist who was scheduled to speak at the conference, however, was skeptical about the plan in his comments published in the journal. "The stunted public health system is hardly geared up to absorb increased allocation. Already state governments are returning allo­cated money because of their inability to absorb increased allocations," he wrote.
The National Health Bill 2009 — which addressed issues like equitable access health facilities and drugs as well as safe water and sanitation, Sen said, makes no commitment to public financing.
The idea of integrating the private sec­tor into the national healthcare system has also attracted criticism. "The corpor­ate-led private sector cannot be con­trolled by integration—it has to be conf­ronted by being made to compete against a well-resourced and managed public system that is run by public fun­ds," Amit Sengupta, of the Jan Swasthya Abhryan, said.

Situation
·        Over three-quarters of health spending in India is paid privately
·        Spending on drugs constitute about 70-80% of out-of-pocket expen­diture for outpatients,
·        Health expenditure is pushing 39 million Indians into poverty every year
·        With 1.8 million deaths among children below five years and 68,000 deaths among mothers every year, India's burden of reproductive and child health and nutrition is bigger than any other country. About 52 million children are stunted as well



The way ahead :
·        Bring down the percentage of  pocket expenditure from 78 to 20 per cent
·        New resources can be  raised from increased taxa­tion on tobacco,  alcohol and junkfood
·        Constitution of a national Insurance fund, financed by public employers and private sources
·        A regula­tory system to ensure the quality of health-care, drug prices and patients1rights needs to be set up



Tax the Junk Food to fund medical plan

THOSE fighting against levying user charges in healthcare institutes such as the All India institute of Medical Sciences (AIIMS) stand vindicated. A high-level group of experts and scientists has opposed the trend of charging for services in government hospitals.
User charges can never be a source of revenue as is argued by proponents of a user fee, the experts said. Instead, additional resources for health should be generated through Increased taxation on tobacco, alcoholand energy-dense junk food, they said while releasing a series of research on India, published in The Lancet
"We know from experi­ence on user charges from across the world that these cannot be a major source of revenue. User fee actually leads to denial of access to healthcare services," Dr A.K. Shlvakumar, from UNICEF India and one of the scientists who worked on the series, said.
A November 2010 circular at AIIMS had drawn criticism from some scientists and doctors at the Institute. The group said It was an attempt to increase cha­rges for services. Later, the government clarified that onlycharges for private rooms and serv­ices would be upwardly revised.
Experts said the government should go in for universal (sing healthcare by increasing taxes on tobacco, alcohol and junk food. Increase in taxes could also give additional health benefits through reduced con­sumption of such products. "Tax-based financing of health sector is the solution. Even insurance is not the answer as a majority of people cannot afford to pay the premium," he said. Only less than 10 per cent of households have health insurance.
The main reason for India's poor performance In health i sector is the lack of adequate ; investments. With government; spending only about one per 1 cent of GDP on health, India Is i among the countries which • spend lowest In health. Countries like China, Sri Lanka and Thailand are spending two percent or more of GDP on health.
 "The result is that 78 percent of spending on healthcare is ' out-of-pocket by the people,"
 Dr K. Srinath Reddy, Public s Health Foundation, said
According to a PTI report,    when asked about the naming of the superbug NDM-I after
New Delhi, lancet editor Dr Richard Horton said,  "It should not have been named
after a city.... It was an error and I apologize. I think it should be renamed, but it should be up  to the microbiologists (who discovered the superbug)."

Er. S. C. Maheshwari


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