Right to healthcare
The conceptualisation of universal healthcare will be incomplete unless there are set parameters for unconditional healthcare access
In the 58th session of the World Health Assembly (2005), universal healthcare was defined as providing access to key promotive, preventive, curative and rehabilitative health intervention for "All" at an affordable cost. In countries where a majority of the population either falls into the middle-class category or lives below poverty level, ensuring healthcare for all means that the government has to increase public spending.
The Government of India, for years, has spent around 1 per cent of GDP on healthcare. In a country where one out of five persons is poor, providing free healthcare to the needy was forsaken by lawmakers. Asymmetrical access to all privileges has created a huge gap between the people and resources. However, the 2018 Union Budget has ushered in some changes promising a positive transformation in the existing scenario. Shifting gears from the traditional announcements pertaining to the health sector, the most neglected public interest, "healthcare", has received high importance. The government has taken responsibility to ensure that health coverage is accessible to the low-income strata of society.
Universal healthcare access
Universal healthcare access might seem to be an idealistic dream, but it is a worthy goal to strive for. Economies across the world focus on drafting a variety of policies – whether it be Obamacare in the US or the healthcare systems of countries like Britain and Canada, which have made much progress in this direction. In the Indian healthcare scenario, Modicare is being seen as the next big transforming agent. However, universal healthcare is incomplete without unconditional healthcare access, an element which is elusive to discussions around the topic. The idea being that anyone who needs healthcare services should receive them, without being discriminated by colour, caste, creed, country, race, ethnicity or religion. In a secular democratic republic like India, two other factors play a major challenge in universal healthcare access, cost, and criticality.
Healthcare is not only inaccessible to a large population in the country, but it is also denied to lakhs by being unaffordable. Urban India can still afford medical attention which involves 70 per cent out of the pocket expenditure. Reimbursement of the money comes later through insured agreements. According to the World Bank and the National Commission's report on Macroeconomics, only 5 per cent of Indians are covered by health insurance policies.
A public health report conducted in 2015 suggested that only 25 per cent Indians have access to healthcare while it is estimated that around 75 per cent of the people in India are without healthcare coverage, something which the present government is trying to better by rolling out the Ayushman Bharat policy.
The plan intends to cater to around 10 crore families with a health coverage of up to five lakhs. However, the lack of adequate healthcare facilities, poor and irregular services, the absence of doctors and medically trained staff to work in rural India are the ground challenges that make healthcare inaccessible to the masses. Only a few private players are working in the rural areas, and mostly NGOs with their inconsistent delivery are active seasonally in these regions.
In our experience of establishing ourselves as a profit-making enterprise while introducing healthcare delivery in rural India, we have realised the value of being physically present through our 100 plus centres (and growing), delivering consistent care. As outreach initiatives to neighbouring villages, we also run 700 camps, monthly, taking healthcare at the doorstep of the farmer. Private, for-profit enterprises will be complementary to the Ayushman Bharat policy to implement the ambitious plans.
Criticality of illness
Another factor, "criticality" of the patient, needs a due mention. Denying treatment knowing the severity of a patient's disease is an important malpractice in the healthcare industry which should be corrected. Owing to the duty centric directives of the Medical Council of India's Code of Ethics Regulations (2002), the doctor's duty to treat a patient drives more focus than the patient's right to receive due medical care. On the ground, patients who are deemed as critical and beyond saving are often refused treatment, despite the fact that in recent years the judiciary has established a right to health, and by implication, healthcare as a fundamental right. The denial of treatment, as of today, does not stand to be a cognizable offence. As a result, serious patients lose critical time, making their condition worse.
Here, a larger issue also needs to be addressed by being sensitive to the healthcare providers. India also stands to be a land where expectations from doctors are only second to Gods. Also, best healthcare facilities and premium services have a price attached to it, which hurts the family especially if the patient does not survive. Masses need to be sensitised that money cannot ensure life and also towards the humane, fallible nature of doctors and practitioners. Taken for granted health and demand for absolute health from doctors thinking them to be God has exerted huge pressure on medical professionals. Dissociating "godliness" from medical professionals will pave the way for unbiased treatment. Only a collaboration of unconditional treatment and health awareness can mark the success of the universal healthcare scheme.
It is only through a strong collaboration and engagement between government, NGO, people, and private players can the need for a stronger policy mandating unconditional healthcare access be drafted. While universal healthcare will ensure health coverage for all, unconditional healthcare will ensure dignity for all. India, today, has the potential to become a super economy; it will only be possible when equality and just unconditional healthcare access becomes an essential pillar to the idea of universal healthcare.
(The author is Founder, Gramin Healthcare. The views expressed are strictly personal)