At its core, healthcare is essentially a public service. So its demand and supply cannot be left to the market and can't be limited to care rendered or financed by public expenditure, but must also include incentives and disincentives for care paid for by citizens.
India's healthcare challenges are aggravated by lack of overall coverage of health insurance services. Although the government and some private employers provide health protection, the schemes available to the public are basic and inaccessible to most people. Only about 12-13% of the population has some form of health insurance cover, apart from the 10% covered via government schemes.
What makes for a good healthcare system is universal and adequate access without excessive burden. But there is no one solution for providing such a coverage.
Among all nations, China is similar to India in size, scale and complexity. In selected aspects of disease load, demography and public expenditures on health, India's record may seem mixed compared to the better all round progress made by China. This is due to various reasons: the Chinese government's sustained attention on health of the young, good public policy backed by resources and social mobilisation. However, India has a larger burden of disease compared to China, has to bear the transactional costs of a democracy and the burden of a population younger than China.
Public expenditure on health in China has been consistently higher than India's. Still, it is not too unrealistic to expect that India should be able to reach at least three-fourth of the current level of performance of China in all key health indices soon. Let's examine the effectiveness of available instruments for delivery and financing public health action and how these can be stratified into different phases.
In the short run, India faces challenges that have to do with how we manage the fundamental issues of financing healthcare for consumers, government, providers and other stakeholders.
The current financing of healthcare is based on a tripod structure. First, there are schemes like Rashtriya Swasthya Bima Yojana and Arogyashri that are doing a great job and should be strengthened further. But the complete onus of running the programme lies on the State because the beneficiaries are the poor from rural areas. In the long run, the State will need support from private providers and extend the coverage to the urban poor as well.
Second, we have schemes like Central Government Health Scheme and Employees State Insurance that cover the vast majority of our population but their pricing needs to be transparent and corrected for efficient delivery.
Third, there are the private health insurers who cater to the health insurance needs of the middle class. All these models need to be made sustainable and efficient with efficient private-public partnership.
India's healthcare need is growing every minute. But are we ready for tertiary growth that can support regular healthcare needs for all including the urban poor and also be ready for the calamatic needs?
The solution might lie in the creation of a universal healthcare access mechanism where everyone can participate. It may be prudent to create a fund (an insurance pool) for universal care and critical illnesses through efficient private-public partnership built on trust and transparency. This would not only enable universal access but also enhance our readiness to address the growing gap of healthcare demand and supply.
Shobana Kamineni is director, Apollo Munich Health Insurance and Apollo Hospitals
The views expressed by the author are personal