At just 1.2% of the GDP, India’s public health spending continues to be among the lowest in the world, while public health infrastructure in the country faces significant gaps. The National Health Policy 2017 expresses the intent to universalize health care and provide quality care at affordable rates. But several challenges and uncertainties remain for India to realize this goal. There is a pressing need for innovative models of financing healthcare and ensuring quality health service to all citizens across the country.
To shed light on these issues and address the most pertinent issues regarding the demand and supply of quality healthcare, the International Innovation Corps (IIC) organized a panel discussion titled “The Quest for Universal Quality: Financing Healthcare in India” on January 30, 2018. The panel featured Dr. William Haseltine (Chairman and President, ACCESS Health International), Dr. Shamika Ravi (Director of Research, Brookings India and Member, Economic Advisory Council to the Prime Minister of India), and Dr. Dinesh Arora (Director, Health, NITI Aayog). The panel was moderated by Dr. Anup Malani (Faculty Director of the IIC, and a professor at the University of Chicago Law School, and the Pritzker School of Medicine).
The panel discussed a range of issues about the health sector in India – from the need to develop a process for electronic health records to mapping the exact health demand across the country. Some key themes emerged from the conversation:
‘Quality of Care’ needs to be defined and prioritized
Currently, there is a much greater focus on providing access to healthcare than on ensuring quality of care. Quality of care, while a nuanced concept, is critical to ensuring a comprehensive realization of universal healthcare. Quality needs to be defined through the development of robust metrics through which health outcomes can be assessed.
A shift is required in government spending, with an increased focus on increasing awareness and demand
Until now, the government’s primary focus has been on building medical infrastructure and manpower. There has been little focus on the demand side – with limited efforts to increase the public demand of healthcare in order to strengthen the public medical system. This is also evident in the excessively low utilization rates of Government Public Health care schemes, such as the Rashtriya Swasthya Bima Yojana (RSBY). Thus, a systematic approach to awareness building needs to be adopted to ensure that citizens access the healthcare avenues and schemes provided by the government. Concurrently, with these demand-side gaps in mind, policies with simpler instructions and more streamlined operations need to be designed so that they may be easily accessed.
A strong accountability and performance incentive structure is required to improve service delivery
Comprehensive access to equitable quality care is only possible when there is strong accountability in service delivery. Electronic health records and digitized intermediary processes (such as HMIS) that facilitate studies of patient flow and the management of medical facilities are a step in this direction. At the administrative level, the ranking of states based on their performance on health indicators would likely incentivizes states to invest a greater effort.
Robust medical data infrastructure is critical to enhancing the efficiency of healthcare processes
India’s healthcare system collects an enormous amount and wide variety of medical data. Despite this, there are serious issues across the data management cycle, which greatly reduce the data’s usability and amplify the data gaps. From non-standardized practices in data collection and compilation to inefficient analysis, a range of challenges make the data collected unhelpful and ineffective in decision making. In light of this, it is crucial to develop robust infrastructure, while redesigning existing data management processes.
Ultimately, the real challenge for realizing Universal Health Coverage lies in the implementation of processes. This will require a balanced approach to the demand and supply of healthcare, but a central focus on quality will be critical to this effort. The successful implementation of Universal Health Coverage will also need proven processes and methods to increase accountability, as well as a channel of systematic financing, to ensure that decision making is driven by data and evidence.