Rekuram Varadharaj, Co-founder and COO, healthi states how UHC can be achieved and sustained
On September 25, 2015, during the Sustainable Development Summit, member states of the United Nations agreed to the 2030 Agenda for Sustainable Development comprising of 17 Sustainable Development Goals (SDGs). On the occasion, the UNDP Administrator Helen Clark stated, “This agreement marks an important milestone in putting our world on an inclusive and sustainable course. If we all work together, we have a chance of meeting citizens’ aspirations for peace, prosperity and well-being, and to preserve our planet.
This was a crucial statement since the third Sustainable Development Goal addresses the need for ‘well-being’ of the global population, especially in the poor countries where universal health coverage (UHC) has so far been a pipe dream only.
The technological advancement and introduction of new medicines, vaccines and treatment processes have all positively impacted factors like average life expectancy. However, the healthcare benefits are not evenly spread all over the world. While in developed countries, life expectancy is 82 years for males and 76 years for females, it comes down to 66 years and 63 years respectively for the least developed countries. Preventable diseases such as measles and tuberculosis are killing 16,000 children every day on an average. Thus, adoption of UHC on a global scale is the need of the hour. It has already been well-documented that implementation of UHC policies has resulted in notable improvement in public life as well as the financial and social growth of populations.
The key to implementation of the third SDG as envisaged by the United Nations members lies in the adoption of UHC. There is ample evidence and past precedence of how UHC has in turn led to improvement in public life and enhancing financial and social growth. A flawed argument against UHC is that it is only a pipe-dream for the poor countries and would incur huge costs to implement. The truth is contrary. The proponents of the ‘exorbitant economic cost’ of UHC fail to look at factors beyond budgetary amounts while passing their judgements. The fact that basic healthcare services are predominantly labour intensive, and labour costs are significantly lower in the poor countries, is often overlooked.
Simply put, a $1-billion UHC budget might be insufficient for a US state like New York or California due to the expensive manpower, but it could be enough to fuel UHC projects in an Indian state like Orissa.
Thailand is a shining beacon when it comes to exemplifying successful implementation of UHC in a financially backward country. Prior to the turn of the millennium, Thailand had a major healthcare coverage disparity among its population. About one-fourth of the population had access to reasonable insurance coverage. This section of population was mostly comprised of government servants or organised private sector employees who enjoyed mandatory social security. The remaining three-fourths had to pay for any healthcare services availed. Thai government launched a revolutionary “30 baht universal coverage programme” in the year 2001 and it covered the whole population uniformly. The salient feature of the programme was the imposition of a 30 baht ceiling for the cost of medical care per visit and the poorer section (25 per cent of the population didn’t need to pay even that cost. The UHC programme in Thailand has resulted in a clear drop in mortality rate (especially infant and child deaths) and an impressive rise in life expectancy (over 74 years). Thailand has also successfully bridged the gap between infant mortality between the poorer and wealthier regions.
It would be appropriate to say that implementation of an all-encompassing UHC is not as difficult as it seems; a major benefit being the economy of scale. For example, vaccination drives reach a large number of people in the same neighbourhood and not just one person at a time. In economic parlance, healthcare has a lot of the components of a “collective good.”
The Indian Context
In the current out-of-pocket healthcare scenario, patients rely on costly, inefficient, and often incorrect private healthcare. Patients are generally clueless about the treatment required for their problems, or the specific medicines that can better cure them. In fact, many don’t even know what medicines are being given to them as a cure. This ambiguity leaves them vulnerable to exploitation and exposed to quacks. In India, we can see both scenarios (UHC vs out-of-pocket) operating in tandem in different states. The state of Kerala provides highly dependable, but rudimentary healthcare for all through public channels. However, rising economic stature and disposable incomes are making a lot of people show willingness to pay more for better personalised healthcare. Since the private sector providers need to prove that their services are superior to state sponsored services, they are compelled to deliver higher standards of healthcare services.
Comparatively, such services are far better than similarly priced services in states where there is no UHC competition and a lower level of public education. Such exploitative and inferior healthcare services are what bulk of the population in states like Madhya Pradesh and Bihar gets at a higher cost.
In conclusion
In a complex and highly populated country like India, UHC is a must and it should be implemented in tandem with the private sector healthcare innovations. There must be an emphasis on provision of basic medical care, accurate diagnosis and imparting only the healthcare that a patient actually needs. While the state-sponsored UHC services should focus on in-patient treatment, surgeries and other labour-intensive healthcare coverage, the private sector players can bring in digital technology integration to deliver faster and more accurate diagnostics and other such auxiliary services. There is no doubt that UHC is not a pipe-dream anymore, but an affordable, implementable solution with far-reaching positive results for the well-being of the nation!
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