The Covid19 induced health emergency and its catastrophic impact on the social dynamics and economic growth of India has brought healthcare back to the forefront. The Economic Survey 2020-2021 looks at the impact of the pandemic and lays out a plan to make healthcare in India inclusive, affordable and accountable.
While the pandemic has been a wake-up call for analysts and governments to prioritise healthcare reforms, persistent problems like manpower shortage in delivering healthcare and information bias resulting in market failure continue to dog policy makers. Yet there is a silver lining, where the advent of technology has resulted in the growth of telemedicine and platforms poised at streamlining healthcare delivery across the country. Here is a look at some of the highlights of the survey.
- Healthcare policy must not become beholden to saliency bias
Recent data from the Global Burden of Disease Report 2019 states that 65 per cent of deaths in India is caused by non-communicable diseases (NCDs). Between 1990 and 2016, the contribution of NCDs increased 37 per cent to 61 per cent of all deaths in India. Whereas, the contribution of CDs decreased from 56% to less than 10% of deaths, this reduction can be attributed to focus on bolstering sanitation in India and awareness about hygiene etc. Whereas lifestyle diseases and non-communicable diseases requires specialised attention and medical infrastructure that can be expensive for a majority of Indians.
The Government has acknowledged growing Out of Pocket Expenses (OOPE) among Indians and the disproportionate corelation between public spending on healthcare and OOPE. The current observation is that countries with higher expenditure on healthcare have lower OOPE and the survey reiterates the recommendation from the 2017 National Health Policy calling for increasing the current allocation of 1% of GDP for healthcare to 2.5 or 3%. This is to cushion citizens from spending money on healthcare and save millions from slipping into poverty. The objective of this is to reduce OOPE from the current 65% to 30% of all overall healthcare spend.
Moreover, the way forward is to ensure that India equips itself to address emergencies emanating from the spread of communicable diseases like Covid19 but it is also equally important to ensure that action does not derail the process of addressing other health concerns.
- Harnessing Telemedicine for Remote Areas
The survey also pins its hopes on telemedicine and the influence of tech platforms in scaling up digitisation and implementation of artificial intelligence in healthcare. The imposition of lockdown in 2020, coinciding with the Ministry of Health and Family Welfare publishing the Telemedicine Guidelines in 2020 saw increased demand for telemedicine. Government of India’s platform e-Sanjeevini and private players have seen over 500% increase in tele-consultation since April 2020.
The demand for teleconsultation is largely among the more affluent class of people residing in urban geographies with access to internet. The economic survey however, proposes bridging this divide by bolstering the ongoing BharatNet optic fiber network in the Gram Panchayats (GP) across India. While access to internet is crucial to the success and inclusivity of telemedicine, the goal to connect all 2,50,000 GPs in India still remains slow with repeated extension of deadlines leaving many GPs left without broadband connectivity. Internet penetration is still subjective, with a large proportion of Indians dependent on mobile network than broadband.
Far more glaring is the gender disparity in accessing the internet – in 2019, the IAMAI reported that the breakup between male and female with respect to access to internet in India level is 67% and 33%, respectively, the breakup in urban areas is 62% and 38%, respectively. In the rural areas, the gap is wider with men accounting for almost two-thirds of the internet users at 72%, while women account for a meagre 28%. This pretty much means that a large majority of women, will either have no access to telemedicine facilities or remain dependent on men for access to healthcare.
- Ending Information Asymmetry Resulting in Market Failures
Patient misinformation and lack of communication between healthcare giver and patients results in information symmetry. According to data from NSSO, around 74 per cent of outpatient care and 65 per cent of hospitalisation care is provided through the private sector in urban India. The survey calls for a new regulatory authority to regulate the private sector and priorities welfare over profits. The survey calls for implementation of the Quality and Outcomes Framework (QOF) introduced by the National Health Service (NHS) in the United Kingdom after careful evaluation.
Similarly, the survey attributes information asymmetry for high health insurance premiums and calls to limit adverse selection among insurance companies. However, this would mean more access to medical data and other personal data of patients resulting is possible moral hazards. It is important the Government designs a strong data protection legislation before moving towards assessing and disseminating private health records of citizens.
- Manpower Shortage in Healthcare Delivery
The survey touches upon the human resource shortage in healthcare and the need to bolster the numbers of professionals for better healthcare delivery. It does not however talk about ways in which manpower deficit can be addressed or overcome. Moreover, the distribution of doctors varies from state to state, and between urban and rural areas. According to the Ministry of Statistics & Programme Implementation report 2019, states like Kerala and Jammu and Kashmir have a high density of doctors, while states like Punjab, Himachal Pradesh and Chhattisgarh have a larger number of nurses and midwives but very low density of doctors. Only Andhra Pradesh, Delhi and Tamil Nadu shows a balance between doctors and allied healthcare professionals.
Last year’s economic survey recommended increasing the number of medical colleges to meet the growing demand for healthcare. The Government through the National Medical Commission Act, 2019 has made community health workers and ayurvedic practitioners at power with medical doctors, which has drawn severe criticism from the medical fraternity.
More needs to be done to address the manpower deficit and imbalances, for example a look at state regulations regarding the registration and licencing of doctors needs to be uniform. The process of migration of practitioners from once state to another involves several levels of bureaucratic procedure involving multiple state medical councils. While the objective of states is to retain doctors, this unfortunately results in lop-sided health workforce across states leaving certain states under-serviced.
Similarly, there needs to be a more concerted effort to manage the welfare of all sections of medical professionals, including nurses and technicians, the current system forces professionals to seek better livelihoods abroad.
Additionally, technology must be leveraged to bridge information asymmetry among practitioners with respect to vacancies and wages. Many medical graduates and professionals find it difficult to secure a job with transparent wages, forcing many of them move to larger cities with the hope of better paying jobs and other opportunities. Whereas, they are unaware about the demand for service and wages in hospitals in smaller cities and non-urban areas.
The Economic Survey raises relevant points around kickstarting the economy while keeping in mind the influence of health and wellbeing of the population on the economy. It is time for the centre to makes changes that can bolster both tech advancement in meeting healthcare demands and addressing manpower shortage. Information asymmetry is not only confined to insurance or the information gap between hospitals/doctors and patients but also valid while discussing deficit of man power in certain states or areas. The Central and State Governments must ensure that these factors are taken into consideration while we move forward amidst the pandemic.