In August, the United Kingdom celebrated 75 years of its National Health Service, arguably one of the best universal and uniform health schemes in the world.
In the words of British politician Nigel Lawson, “given the status of the NHS as a beloved national institution, it is the closest thing the English have to a religion”. The country’s love for the National Health Service is evident with citizens proud of their healthcare system – though there have been demands for improved funding reform.
But, the celebration of the National Health Service is a reminder of India’s healthcare system that remains broken in the country’s “amrit kaal”, or era of nectar.
If for the English the National Health Service is like religion, it appears that in India, religion is above everything else – even health. A true realisation of India’s “amrit kaal” will be in taking firm steps to ensure universal healthcare coverage, instead of the poison of hate and intolerance.
Will a National Healthcare Service-like system remain a mere dream for Indians?
As it stands, healthcare delivery and coverage in India is neither national nor universal and certainly not uniform. But India stands at a critical juncture where healthcare is concerned and must choose the right path. Further neglect may result in it being too late to build an effective universal healthcare system.
There are two time-tested models of effective universal healthcare in the world: the tax-funded models like in the United Kingdom, Sweden, Denmark, New Zealand and Canada, and the social insurance models in Germany and Netherlands. Although both have their advocates, it is generally recognised that for poorer countries with greater income inequality and less social solidarity like India, a tax-funded system like the National Health Service is better.
Healthcare in India today
Healthcare in India today possibly resembles what may have been the situation in the United Kingdom 75 years ago. If that may be a dreadful memory for the English, what Indians must fear is the country’s healthcare hurtling towards a situation like in the United States – a universally accepted broken system.
Like in the United States, healthcare in India is overwhelmingly privatised, underinsured – far more than in America – and at the mercy of private players seeking to make profit. Initiatives like Ayushman Bharat – the Centre’s health assurance scheme providing coverage to families – and the myriad state-level schemes are not taking India towards a robust universal healthcare system.
On the contrary, they are encouraging further dependence on private healthcare, thus facilitating profiteering, and corruption. These schemes are being sold by politicians to the public as a panacea. For the poor, these schemes may well serve the perception that “something is better than nothing”. For India’s wealthy, there are five-star hospitals – far better than those in the National Health Service – and they could not care less about the rest.
What India must urgently do is to improve its existing public healthcare delivery system.
Not just treatment, but prevention
For most politicians, universal healthcare ranks low on the list of priorities. There have been sporadic remarks over the years. In 2019, Congress leader Rahul Gandhi had spoken about building a National Healthcare Service-like system in India. More recently, Delhi Aam Aadmi Party has taken some steps to improve the public healthcare infrastructure, as seen through the mohalla clinics.
However, good healthcare is not just appropriate treatment but also the prevention of illness. Other social determinants of health that are equally important are food security, access to education and good public housing. Singapore, which spends a relatively lower percentage of its gross domestic product on direct healthcare, believes that the money thus saved must be pumped into the other social determinants of health. In New Zealand, the Public Health Agency puts “greater emphasis on equity and the wider determinants of health such as income, education and housing”.
In countries where universal healthcare exists, the emphasis is on “public” as against private, be it the public health delivery infrastructure, public education or public housing. Time and again, experts have reiterated this, but India continues to drift – consciously or blindly – down the disastrous path of increased privatisation of healthcare, education and housing. This will only make Indian society more unequal and unjust. What good is a $5-trillion economy if it cannot give citizens good health and robust and universal health coverage?
It is also the duty of the medical community and its professional associations to ask tough questions of political parties about how they propose to work towards universal healthcare. As doctors, our job is not only to keep people healthy but also warn them of the poison that is so callously and widely prescribed to them today.
Dr Santosh Karmarkar is a consultant paediatric surgeon in Mumbai.