National health service in India

National health service in India

Introduction

• India’s fragmented, often corrupt, urban-centred, elite-focused and wretchedly underfunded agglomeration of clinics, hospitals, and variably functional primary health centres can look like no more than an accidental collection of institutions, staff, and services.

Need for higher public spending on healthcare

• India’s public spending on health is set to double in the 2021-22 financial year, but that is from a figure that has long been only a little over 1% of GDP.
• In certain rural areas, the doctor-population ratio is over 1:40,000.
  • India’s healthcare providers, however, have the task of serving 1.4 billion people.
• Medical expenses constitute the major reason for personal debt in India, whether the causes are episodic afflictions or, for example, those caused by environmental conditions which none can escape, such as air pollution (which the journal Lancet Planetary Health says this accounted for 1.7 million deaths in India in 2019; the annual business cost of air pollution is currently estimated at $95 billion, which is about 3% of India's GDP).

Bhore Committee on National health service

• In effect, COVID-19 may bring about serious consideration of an Indian national health service.
• In 1946, the civil servant Sir Joseph Bhore submitted to the then government a detailed proposal for a national health service broadly modelled on the British National Health Service or NHS, which was on the way towards legislative approval in Britain.
• Bhore went further by recommending that preventive and curative medicine be integrated at all levels.
• The result of British national health service post second world war is a mighty achievement in public policy, politics, and the provision of top-class universal healthcare, including training, research, and changing engagement with the public as society changes.

Components of British NHS

• The service is funded entirely from general taxation.
• The budget includes payment to general practitioners, most of whom remain private providers but are paid by the state for treating NHS patients.
• Items listed in general practitioners’ prescriptions incur no charges in the devolved regions of Scotland, Wales, and Northern Ireland, and in practice only a proportion of patients in England have to pay for prescription items.
• All hospital treatment and medicines are free, as are outpatient and follow-up appointments.
• The British public share the costs through their taxes, and almost without exception receive treatment solely according to their clinical needs.
• With about 1.1 million staff, the NHS is the largest employer in the U.K.
• Its current budget is about 7.6% of GDP, but despite its size and scale, it provides highly localised access to care.

Problems in the NHS

• Largely unintended inequalities in the time and attention given to patients of different social classes (this discovery resulted in substantial changes), huge and frequent reorganisations imposed by Central government, and often ideologically driven underfunding.

Way ahead

• India now faces a very serious health crisis, possibly the worst since Independence.
• By all accounts, several areas of the Indian healthcare provision are under severe strain.
• The precise structure envisaged by Bhore may need some adaptation for today’s society and conditions but dealing effectively with the pandemic may itself require the urgent creation of an Indian National Health Service.