The public health system plays a crucial role in ensuring the well-being of a society, yet it grapples with limitations in providing universal health coverage. These limitations often stem from resource constraints, bureaucratic inefficiencies, and an overwhelming demand for healthcare services. In light of these challenges, the question arises: can the private sector contribute to bridging the gap and improving overall healthcare accessibility? While the private sector has the potential to alleviate some of the burdens on the public health system, it is not without its own set of challenges, such as affordability and the prioritization of profit over public health. To strike a balance and ensure comprehensive healthcare for all, a multi-faceted approach is essential. One alternative is fostering public-private partnerships, leveraging the strengths of both sectors to optimize resource allocation and enhance service delivery. Additionally, promoting community-based healthcare initiatives and preventive measures can reduce the strain on the system by addressing health issues at their roots. Furthermore, investing in technology and telemedicine can extend healthcare services to remote areas, ensuring that even marginalized populations have access to essential medical assistance. By embracing a combination of these strategies, a more resilient and inclusive healthcare system can be forged, transcending the limitations inherent in a solely public or private approach.
Tag: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Decoding the Question:
- In the Introduction, you can give the Bhore Committee’s recommendation and a three-tiered health care system in India.
- In Body, try and divide into the sub-headings as mentioned below and elaborate:
- Public Health System Has Limitations in Providing Universal Health Coverage.
- The Private Sector Can Help in Bridging the Gap.
- Other Viable Alternatives.
- In Conclusion, conclude with Sustainable Development goals.
Answer:
The noble vision of Universal health coverage (UHC) is about ensuring all individuals and communities have access to the healthcare they need. UHC does not mean healthcare is free, but that personal out-of-pocket payments do not prevent or dissuade people from using health services, and that people are shielded from “catastrophic health expenditure” which implies not spending more than 30% of their household income on health.
Report on the Health Survey and Development Committee, commonly referred to as the Bhore Committee Report, 1946, is a landmark report for India, from which the current health policy and systems have evolved. The recommendation for a three-tiered healthcare system to provide preventive and curative healthcare in rural and urban areas placing health workers on government payrolls and limiting the need for private practitioners became the principles on which the current public healthcare systems were founded.
Limitations of Public Health System in Providing Universal Health Coverage:
- Public Health expenditures around the world, particularly India, are rising. It is driven by the emergence of a dual burden of communicable and non-communicable diseases and the increasing life expectancy across all demographic segments.
- Government spending as a percent of GDP has stayed between 1.1-1.4% of the GDP over the last decade and out-of-pocket personal expenditure is filling the gap of nearly 65% of total spend. A June 2019 World Bank report found people in developing countries, including the Caribbean, spend half a trillion dollars (over $800 per person) annually on out-of-pocket payments. In a country like India, where per capita GDP is USD 2,143, this is not sustainable nor affordable for a vast majority of citizens.
- It is thus not surprising that healthcare financing in India is neither sufficient, efficient, or equitable.
- About 55 million Indians were pushed into poverty in a single year because of having to fund their healthcare and 38 million of them fell below the poverty line due to spending on medicines alone, a 2018 study from the Public Health Foundation of India has estimated.
- The COVID-19 pandemic brutally exposed the health system: The immense political capital around COVID-19 suddenly put pressure on the health system to rapidly ‘scale up’ health services like never before.
The five areas where private sector contribution can prove beneficial are:
- Infrastructure Development: Development and strengthening of healthcare infrastructure that is evenly distributed geographically and at all levels of care.
- Management and Operations: Management and operation of healthcare facilities for technical efficiency, operational economy, and quality.
- Capacity Building and Training: Capacity building for formal, informal, and continuing education of professional, para-professional, and ancillary staff engaged in the delivery of healthcare.
- Financing Mechanism: Creation of voluntary as well as mandated third-party financing mechanisms.
- IT Infrastructure: Establishment of national and regional IT backbones and health data repositories for ready access to clinical information.
- Materials Management: Development of a maintenance and supply chain for ready availability of serviceable equipment and appliances, and medical supplies and sundries at the point of care.
Other viable alternatives:
As per a study by the Public Health Foundation of India, about 55 million Indians were pushed into poverty in a single year due to exorbitant patient care costs in private hospitals.
Thus, the following alternatives are suggested to reduce cost and increase quality:
- PPP models can be utilized
- Upgrading the infrastructure of existing hospitals and clinics
- Investing in secondary and tertiary care provisions
- The local population can be imparted with primary health care skills. Ex- ASHA, Midwives
- Supporting innovations in healthcare that benefit the poor and vulnerable populations
- Medical graduates from government colleges should be encouraged to serve in rural posts.
When the world committed to ending poverty, protecting the planet, and ensuring prosperity for all with the 17 Sustainable Development Goals, it was known that no single entity would be able to achieve such lofty goals, it would take collaboration. A successful sustainable development agenda requires partnerships between governments, the private sector, and civil society, Goal 17 stated. Health is a state subject, and despite the issuance of the guidelines by the central government, the final prerogative on implementation of the initiatives lies with the states. In this regard, the Central government along with state governments, private players, and other stakeholders need to collaborate for a better and sustainable health system in India.
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