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Need focus on health, not medical insurance

E Kumar Sharma     February 6, 2018

Healthcare is the flavour of the season and almost every day since the budget there is some mention of the reach that a state has achieved or the plans unfolding in yet another state. So, while this may seem good news for the end consumer seeking better health, there is a risk of running disconnected elements and more important, the danger of missing out on a deeper issue of how we approach better health outcomes.

For a country where citizens make more out-of-pocket payment on hospitalisation, healthcare coverage, as announced in the budget, may seem the way forward. But, given the current realities, they are going to result in limited outcome, even when they get fully implemented, for there are still endless questions being raised on the execution mechanisms and the implementation architecture apart from the outlay required. A more serious and deeper point is on why we are opting for expanding medical insurance / coverage instead of focusing on a more deeper and comprehensive approach to health which also means attention to providing access to preventive, curative and rehabilitative services. Going beyond insurance is apparently crucial.

"Public insurance schemes tend to result in private hospitals getting a steady supply of patients, adding in turn, only to their greater viability," says Rama V. Baru, Professor at the Centre of Social Medicine and Community Health at the Jawaharlal Nehru University, who has studied this subject closely over the years. Instead, what is needed, she feels, is attending to health needs right from primary level care - the immediate medical needs - coupled with enhanced investments into better sanitation, water supply and nutrition. In short, an inter-sectoral approach to improve health outcomes. This translates to increasing the outlay for public health, strengthening the primary and secondary level care and investments into building the human resources needed to overcome the shortages of qualified doctors, specialists and nursing staff.

Good as the text of the budget may seem on this subject, there is little doubt on what needs to be done. For as things stand, Dr K Srinath Reddy, President of the Public Health Foundation of India, feels the plans announced in the budget would have limited impact unless measures are first taken to strengthen primary care in a manner that it will act as a gatekeeper that reduces the need for secondary and tertiary healthcare services. This coming from a doctor only underlines its importance.

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