Articles

The improvements in our health delivery system in the last 50 years have not kept pace with the needs of a majority of our people. A major reason for this has been that health services respond to the existing "market demand" and needs of a majority of the people do not figure as part of this demand.

Inadequate resources:

This is compounded by inadequate resource allocation and inequitable distribution of such resources with a clear bias for urban centres. There has been little effort to sustain investment to build our healthcare infrastructure. To be fair, periods of stagnation have been punctuated by sporadic efforts to enhance public health funding - like the National TB and Malaria programmes of the fifties and sixties and the Primary Health Care Programme in the late seventies and early eighties. However even in these cases, most of the gains were frittered away as the matching investment did not support the initial infrastructure created. The fallout of the new policies was a cut in budgetary support to the health sector. Cuts were severe in the first two years of the reforms, followed by some restoration in the succeeding years bringing them to the levels of the pre-reform period.

Limited funds:

The compression of funds has a number of far reaching effects. Expenditure on salaries and infrastructure constitutes 70-90 percent of expenditure for most programmes. Faced with limited funds while salaries and infrastructure still require to be maintained, the burden of cutbacks is placed on supplies and materials. Ultimately a skeletal structure survives. Today, prescriptions for restructuring of the health sector are designed to maximise outputs from greatly reduced government support. At 22 percent, the government's share of the total expenditure on healthcare is one of the lowest in the world. It may be contrasted with 70-80 percent in North Europe and 44 percent in the US.

Privatisation:

The government's new-found fascination with health insurance is designed to facilitate privatisation of the health sector. Wary that a total collapse of the public health infrastructure would also affect the more vocal sections of the people the elite and the middle class health insurance is seen as a useful ploy to replace the state health sector. But such a system addresses the needs of a small fraction because when the state today talks of health insurance, it means private health insurance. All countries with a developed health care infrastructure have health insurance, but in most the major share is made up of by state supported health insurance.

For instance in Japan, France, Canada, England and Netherlands, majority of the population is covered by state funded health insurance. The only large country where private health insurance is dominant is the US, a country that has the most inefficient and expensive health care system in the developed World. It is foolhardy to argue that health care delivery would improve in India if the government sector were replaced by the private sector. In fact there is a need to greatly increase the involvement of the government in providing healthcare.