Yesterday morning I was billeted in a training session on Edward de Bono’s Six Thinking Hats and the power of parallel thinking. Out of the blue the trainer asked the group to discuss the topic ‘Should Healthcare be free in India? The group that discussed this had well educated professional managers and senior executives. However none of them had a background in healthcare services per se.
Many people in this group felt that healthcare services should indeed be free in the country, pretty much like roads. Those with a a legal view supported this argument by pointing out that our constitution guarantees the right to life as a fundamental right and healthcare services can not be divorced from the right to life. A gentleman in the group gave the example of NHS in the UK and said that inspite of problems, it works. Many felt that in the face abject poverty in many parts of the country, it is only right that people have access to good quality healthcare at the expense of the government.
Those who opposed the ‘free healthcare for all’ proposition believed that while the concept sounds good, it is Utopian and impossible to implement. They pointed out that since many in India do not still have access to clean drinking water, two square meals a day and a roof over their head, should the government also ensure these being available to millions for free? Where will the government find the resources for something like this? And with the monumental inefficiency and corruption, which is endemic to our government, how will these schemes be implemented. Where will we find honest politicians and upright bureaucrats, who will ensure that the government resources are channelised properly. Moreover, India being a vast under developed country how will we find enough doctors and other medical professionals, who will be willing to work in rural India. After all, India is a free country and no one can be forced to work against his wishes. Another argument put forth was that if the government pays for everyone’s healthcare, we will have a situation, where 30% tax paying population will end up paying for the healthcare for the 70%, who are presently out of the tax ambit, which would be inherently unfair.
Some in the group had other solutions and felt that the answer probably lay somewhere in between. A Private-Public Partnership (PPP) was suggested as a possible alternative, where in the governnment can invite private players to partner in healthcare ventures jointly owned by the government and the private player. These hospitals can then offer healthcare services to the poor at low costs, while the rich will be charged on a full service basis. Most people felt that the involvement of private equity will ensure greater efficiency and better utilisation of the public funds. This arrangement it was felt can work well if it is properly regulated by an independent regulator.
Health insurance was also suggested as a possible solution. The government can subsidise the insurance premium and get publicly owned health insurance companies to sell health insurance policies to the poor. The insurance companies will remain viable as they will have a large customer base, the government will pay let us say 50% of the premium and the balance will be paid by the end user. Those above a ceratain economic criteria will have to compulsarily buy medical insurance at full market determined rates of premium, pretty much like motor insurance. (Isn’t it strange that it is mandatory for car buyers to have motor insurance and not health insurance). Micro insurance schemes like the ‘Yashaswini’ being championed by Dr. Devi Shetty of Narayana Hridayalaya in Bangalore were also discussed as possible solutions.
Frankly, I was quite surprised that a group with no expertise in healthcare could debate and come up with some of these ideas. Wouldn’t it be wonderful if we can have a government and a health minister who can look at some of these suggestions seriously and work towards facilitating a universal healthcare system that is efficient, takes care of the most vulnerable sections of our society and ensures good quality healthcare for all.
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