Social Health Insurance (SHI) is desirable to both statist or market driven models.
A health care network that is accessible, economical and effective must necessarily be developed by India. Mandatory preconditions like freedom to choose and optimal client say should be included. Exceptional care is as important as access. The health sector agenda will include pooling of resources, primary care, promoting economy hospitals in public and PPP sectors, health information sources, health laws and regulation, promoting AYUSH, control of important diseases, Health Human Resources (HHR), rational use of drugs and technology, healthy demographic change and a better role for states and local governments.
The attention gaining issues are health finance and Human Resources (HHR). The Srinath Reddy committee recommended 2.5% of GDP (about 1.2% till last FY) for providing a free Universal Health Care (UHC) package supported through tax source.
However this ambitious plan needs above 5% of GDP. This is feasible only through pooling of private and public health-spending.
Efficient SHI systems are working well in Germany, South Korea and China etc. SHI can negotiate our diversity and offer some space for control/ participation by users including middle classes. The current private spending (about 2500/ Rs PCPI) needs to be harnessed as pre-payment for SHI.
The SHI requires small co- payments at the point of service. BPL families can receive free UHC from Govt support. The SHI model is a lot different from the miserable US care based on private insurance, not to forget its high costs (at 16% of US GDP).
HHR is another problematic front. Around 60% of basic specialist positions in rural hospitals are vacant, minimizing the quality concerns in referral care.
Here are some things that could be done to solve the stated problems. The first is taking utmost care deeper in rural and urban units. Trained paramedics can tackle some 50 common health problems. Through this we can upgrade SHAs, informal providers and create a million jobs. The ambulance network is a good development, and we need paramedics here too. AYUSH doctors can handle the existing sub centers. Managing the nearly one lakh sub centers to panchayats will also open a new front for local action in primary care.
A wide spread primary care network will ensure preventive programs and bring down hospital-workloads and hence total costs
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