Unconditional access to healthcare crucial

In the 58th session of the World Health Assembly (2005), universal healthcare coverage (UHC) was defined as providing access to key promotive, preventive, curative and rehabilitative health intervention for “all” at an affordable cost. In developing countries, ensuring healthcare for all means that the government has to increase public spending.

The Government of India has for years spent only around 1% of GDP on healthcare. In a country, where one in five people is poor, providing free healthcare to the needy was forsaken by lawmakers. Asymmetrical access to all privileges has created a huge gap between people and resources.

However, the Union Budget 2018 has ushered in some changes promising a positive transformation in the existing scenario. Shifting gears from the traditional announcements pertaining to health sector, the government has taken up the mantle to ensure that health coverage is accessible to those from low-income strata of the society.

UHC might seem an idealistic dream, but it is a worthy goal to strive for. Economies across the world focus on drafting policies of various natures, whether it is Obamacare in the US or the healthcare systems of countries like Britain and Canada. In the Indian healthcare scenario, Modicare is being seen as the next big transforming agent.

However, an element which is elusive to discussions around UHC is unconditional healthcare access (UHA). Ensuring that healthcare services are accessible to all without discrimination on the basis of colour, caste, creed, country, race, ethnicity and religion is essential to realise UHC. In a country like India, two other major challenges face UHA: cost and criticality.

Today, healthcare is inaccessible and unaffordable to a large population in the country. Around 70% of medical expenses is spent out of the pocket by patients in urban India. Reimbursement of the money comes later through insured agreements. According to the World Bank and National Commission’s report on Macroeconomics, only 5% of Indians are covered by health insurance policies.

A public health report conducted in 2015 suggested that only 25% Indians have access to healthcare leaving the rest 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 health coverage of up to Rs 5 lakhs. However, lack of adequate healthcare facilities, poor and irregular services, absence of doctors and medically trained staff to work in rural India are ground challenges that make healthcare inaccessible to the masses. Only a few private players are working in the rural areas, and most 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 the rural region, 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 every month, taking healthcare to the doorstep of the farmer. Private, for-profit enterprises will be complimentary to Ayushman Bharat policy in implementing the ambitious plans.

The other factor, criticality of the patient, needs a due mention. Denying treatment knowing the severity of a patient’s disease is a rampant 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 gets 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; this, despite the judiciary establishing in recent years a citizen’s right to health, and by implication, healthcare as a fundamental right. Denying treatment does not stand to be a cognizable offense. Consequentially, seriously ill patients lose critical time.

Here, a larger issue also needs to be addressed by being sensitive to the healthcare providers. In India, expectations from doctors are only second to God. Also, undoubtedly good healthcare facilities and premium services have a price attached to it. This price hurts the family especially if the patient does not survive. Money cannot ensure life and doctors and practitioners are, after all, human.

Dissociating “godliness” from medical professional will pave the way for unbiased treatment. It is only through strong collaboration and engagement between government, public and private stakeholders that a stronger policy mandating UHA be executed. While UHC will ensure health coverage for all, UHA will ensure dignity for all.

(The writer is founder, Gramin Health Care)