Every investment in combating non-communicable
diseases is a means of promoting development
Providing
every citizen access to healthcare is the dream of all governments. Indeed, the
sustainable development of every nation depends upon the health of its
population. While India can boast of rapid economic development, its unfinished
public health agenda is still worrying.
Non-communicable diseases (NCDs) such
as cancer, heart disease, respiratory disorders and diabetes now jostle
alongside infectious, communicable diseases such as tuberculosis and leprosy,
causing more than 53% of all deaths in the country.
Experts predict that more
than 60 million Indians will succumb to NCDs by 2020. Clearly, the government
must strive to avert the health crisis looming on the horizon.
But this
is no small task, considering that India’s public spending on health is one of
the lowest in the world. According to the World Health Organization’s (WHO)
World Health Statistics 2015, India spent 1.16% of its gross domestic product
(GDP) on health, ranking 187 among 194 countries. In per capita terms, India
ranked 157, spending just $60 (purchasing power parity). The per capita public
expenditure on health was 55% of Indonesia’s, less than 20% of China’s, and 11%
of Mexico’s and South Africa’s.
Despite
being the first country to adopt the Global Monitoring Framework on NCDs and
including it in the draft Health Policy Action 2015, India’s current budgetary
allocation for NCD programmes (targeted at “reducing the number of premature
deaths from NCDs by 25% by 2025”), is a minuscule 3% of the total health
budget. The allocation for communicable diseases and maternal and child health
programmes is larger.
Even
though successive governments have pledged their commitment to the provision of
universal healthcare coverage (UHC), statistics reflect slow progress on this
front. The majority of Indians lack access to affordable, high-quality
healthcare. Thirty per cent of identified illnesses in rural India and 20% in
urban areas go untreated because of financial constraints. According to the WHO
Health Statistics 2012, 39 million Indians are pushed into poverty due to
healthcare costs.
The
latest WHO Global Health Expenditure Database says that 85.9% of total private
health expenditure in India was paid out of pocket by individuals in 2013.
Also, about 47% and 31% of hospital admissions in rural and urban India were
financed by loans and sale of assets.
The
impact of NCDs will only add to the financial burden in a resource-strapped
country such as India with a young and vibrant workforce. According to reports
from the World Economic Forum and the Harvard School of Public Health, India is
slated to lose $4.58 trillion between 2012 and 2030 as a result of NCDs.
Managing the long-term repercussions of NCDs is vital to economic and social
progress. Ensuring universal healthcare coverage calls for a robust healthcare
system, funded by a multi-payer approach.
Global
evidence on health spending shows that unless a country spends at least 5-6% of
its GDP on health, basic healthcare needs are seldom met. NCD programmes
require significant fiscal resources. Though state governments are supposed to
assume responsibility for the healthcare of their residents, the health budget
varies widely from one state to another. Early diagnosis and management are the
most cost-effective way of tackling NCDs. But the absence of facilities,
manpower and resources make quick detection and preventive care a low priority.
Late detection of NCDs increases the costs of treatment and management hugely
across the country. This won’t change until we make integrated service delivery
a reality in more health settings, and consider a new approach to funding that
involves multiple stakeholders.
A
developing economy such as India’s can’t afford to rely on a single public
healthcare financing system to cover the entire population, especially in view
of rising healthcare costs, and the limited access to private insurance
policies and other options to fund healthcare. We need a comprehensive and
diverse system of healthcare financing that pools financial risk and shares the
cost burden. The government needs to consider a multi-payer approach that
includes expansion of commercial health insurance plans and other innovative
financing models that emerge out of public-private partnerships. In fact,
strategic public-private partnerships between central and state governments and
private stakeholders will drive global and national attention to NCDs, attract
more funds and promote the establishment of stronger policies.
Public-private
partnership will play a major role in ensuring wider healthcare coverage that
serves the unique needs of diverse rural and urban populations. For example, a
social health insurance programme designed to provide basic healthcare services
for populations with limited financial means may be the answer for rural and
underprivileged populations, whereas private health insurance schemes may serve
employed urban groups more effectively. The government can assume an important
regulatory role in the private financing of healthcare by assuring the
financial viability of the provider and ensuring inclusive coverage to all.
Ultimately,
the government’s ambitious intention to provide universal healthcare coverage
calls for the kind of policy framework that provides an impetus to programmes
designed to combat NCDs. Public investment in healthcare—the percentage
expenditure of GDP on healthcare—must be raised from the current 1.1% to at
least 2.5-3% by 2025, at the state and federal level, with a greater
appropriation of the budget for NCDs. The new health policy must attract
private investment in the healthcare sector through incentives such as tax
benefits, underwriting and facilitating bank loans to supplement care in remote
and underserved regions. Every investment in combating NCDs is a means of
alleviating poverty and promoting development in the end, since every rupee
spent on NCDs will add to the productive years of life.
Kenneth
E. Thorpe
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