Can we reboot our healthcare system?

In a series of recent dialogues with state chief ministers, India’s Prime Minister, Narendra Modi, accentuated the urgency of deploying reforms that bear a direct and significant impact on the lives of citizens. While the explicit contours of these reforms and the subsequent roadmap for implementation remain hazy, the prevailing crisis has invariably opened doors to rethink and reprioritize the state’s fundamental duties. Two distinct arenas emerge as critically important in this scenario: rectifying the evident flaws in India’s healthcare system and instituting robust safety nets for diverse labor force segments, including migrant workers.

Notably, India’s public expenditure on healthcare has perpetually lagged behind, noticeably undercutting the spending observed in nations with comparable income levels. Despite this glaring discrepancy, there is a discernible propensity to lean towards an insurance-based model. This trend distracts from the imperative need for an expansive growth of public healthcare facilities. The current health crisis has brought to light the shortcomings and constraints of such an approach.

In the 2020-21 Union Budget, the central government dedicated Rs 67,484 crore, accounting for 2.1 percent of its total budget, to health expenditure. Nevertheless, the pressing urgency to significantly amplify government healthcare spending at all levels cannot be overstated. The caveat, however, is that a mere escalation in expenditure may not yield the sought-after results if the inclination towards private healthcare alternatives continues to hold sway. As such, spending plans require a major overhaul to ensure a corresponding enhancement in public healthcare facilities’ quality while fostering accountability for the services rendered.

Primary healthcare deserves paramount attention. Any neglect in this domain propels higher overall healthcare costs and diminishes health outcomes. Moreover, the centralized model of healthcare spending deserves reconsideration, bearing in mind the disparate levels of institutional capacity among the states.

The pandemic has brought the precarious existence of casual wage laborers, including the substantial migrant populace, into sharp focus. Dependent on daily wages and lacking safety nets, these laborers are especially vulnerable. Any decline in their earnings could thrust them into poverty. Consequently, it is of paramount importance to urgently craft a comprehensive social security framework that assures access to healthcare services, provides short-term relief for income loss, and compensates for occupational hazards.

Portability of benefits such as food provisions through the public distribution system is indispensable. In the long run, there is a need to incorporate more individuals into the formal workforce, offering them some form of social security. The government could encourage this transition by subsidizing a part of the social security contributions, emulating the strategy adopted in the Pradhan Mantri Rojgar Protsahan Yojana (PMRPY), where it covers the entire employers’ contribution towards provident funds.

In essence, the current crisis has underscored the urgent need to reassess India’s healthcare system. An increase in public expenditure, coupled with a strategic shift from an insurance-based to a facility-focused model, is the need of the hour. Furthermore, enhancing the social security framework will significantly contribute to mitigating the plight of casual wage laborers and migrant workers. As India navigates these challenges, it has the opportunity to reform, reboot, and rebuild a more robust, inclusive, and sustainable healthcare system that truly serves its citizens.