Notwithstanding the divergent approaches of the BJP and the Congress to health system development; there is room for ensuring that the elected government adopts a balanced approach; based on evidence and sets pathways that will help build; in the long term, a sustainable, equitable and affordable health system. In the absence of a commensurate increase in health budgets; the price; paid by the large swathes of the poor and middle classes; who desperately need good quality primary healthcare. The forthcoming election is going to be an inflexion point for India’s health system story — how affordable, how accessible, how equal?
India’s fragile economic system
Though health is not a political priority as yet; two visions of the future health policy seem to be clearly emerging. One, espoused by the BJP — a centralised hospital insurance-driven health system designed on the Medicare model of the US. The other, of the Congress, calling for guaranteeing every citizen with access to essential health services, resembling the UK and the European model. Both these approaches are widely divergent and will profoundly impact the three pillars of the health system — access, quality and affordability. Given India’s fragile economic system and multiple demands on it, notwithstanding India being the second-fastest growing economy, sustainability will be a major concern.
The two thought streams, propounded by the BJP and the Congress, are embedded in and reflect two social value systems: In the US, it is individual liberty and personal responsibility, while Europe and countries like Japan are driven by ideas of social responsibility and state accountability. The emergence of these two ideological streams had their origins in the rise of Marxism in early 19th century and World War II that devastated UK’s economy, to declare that “Individuals should recognise the duty to be well and restoration of the sick person to health is a duty of the state and the sick person.
The principle of collective responsibility
And so universal coverage as a minimum — a solid and level floor, no interior walls; and a roof that need not; be level but whose height determined; only by people’s own wishes and means”. These approaches and ideas manifest themselves in health policy in different ways. With its strong belief in individual liberty; the US confines itself to subsidised care for the poor and elderly; regulates stringently for quality and allows financial incentives; like profits to encourage technological innovation. As a consequence, it has over 20 million of its population without access; despite spending 18 per cent of its GDP on health.
The UK and Europe, on the other hand; believe in the principle of collective responsibility; ensuring every individual’s inherent right to health and well being; thereby making the state develop financial and regulatory systems that guarantee all individuals equal access to healthcare services and products. These countries spend an average of 10 per cent of the GDP on health with far better outcomes than the US.
This was a powerful message in a country faced with huge inequalities. Some successes have been achieved in implementing affirmative action. Over the years, however, the economic and social models trended; more along the values of individual liberty rather than social equality. Disparities have widened to such an extent that latest data; seems to suggest that 1 per cent of India’s population enjoys 70% of its wealth. While an Indian is among the 10 richest of the world; we also account for the world’s poorest, over 36% of children stunted due to chronic malnutrition, half of the population defecating in the open and nearly three-quarters without access to tap water.
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