The last month marked the completion of three decades since the opening up of the Indian economy. On July 24, 1991, Mr. Manmohan Singh, the then union finance minister, unveiled the historic budget that ushered in sweeping economic reforms in the country. India has made tremendous economic progress over the past 30 years, the impact of which is seen across all sectors. Health systems is no exception to this transformative impact.
The greatest impact of the liberalization is witnessed in the pharma and vaccine manufacturing sector making India not only self-sufficient in drugs and vaccines but also a global leader. Biotechnology caught up soon, followed by the biomedical sector. Private sector healthcare provision witnessed a tremendous growth, especially in major cities and towns. Access to drugs and diagnostics improved even in rural and remote areas. Today, corporate hospitals provide world class medical care to not only Indians, but also to people from other countries. Online healthcare platforms, including tele-consults, home diagnostics, and drug deliveries at home, have been growing rapidly over the last few years making access to healthcare services possible even at home.
Liberalization opened up the entry of the private sector in to medical and nursing education. Today, private sector accounts for nearly 50 percent of the seats available across institutes. Private health insurance has been growing at double digits for the last two decades. Fintech may further accelerate its penetration to wider population.
While the growth of private healthcare improved access, it also resulted in the rapid decline and neglect of public healthcare. As urban India attracted the limited human resources for health, rural India was deprived of formally trained health professionals, resulting in the proliferation of untrained informal healthcare providers. Private equity in healthcare propelled the growth of the private healthcare industry; however, it also led to rapidly rising healthcare costs, nearly two thirds of which is born out of pockets. Catastrophic healthcare costs became the leading cause of people falling into debt trap and impoverishment, ultimately perpetuating poverty.
Even though the quality of healthcare, especially that related to hospitality component, improved in the private sector, accountability and ethics have been declining over years. Expectations of financial returns on investments from private equity imposes undue pressure on medical professionals and healthcare managers to prescribe and provide more services than those actually needed. The net impact of this is people losing trust in public healthcare on account of poor quality and in private healthcare on account of poor ethical standards.
The National Health Policy of 2017 outlined major policies and strategies to address some of the unintended consequences of economic reforms of 1991.
These include the Pradhan Mantri Nan Arogya yojana (PMJAY) to provide financial protection against hospital based healthcare costs to 500 million poor people across the country, the 150,000 Health & Wellness Clinics to strengthen comprehensive primary health care both in rural and urban areas, scrapping of the erstwhile Medical Council of India and creation of the National Medical Council (NMC) through an act of parliament to reform medical education, passing of the Allied Health Professionals Bill to further strengthen the increasingly diverse cadre of human resources for health that is one of the core building blocks of health systems, the National Digital Health Mission (NDHM) to leverage the power of digital technologies in strengthening health systems, and other reforms to aimed at improving the social determinants of health, namely hygiene, safe drinking water, clean energy to reduce pollution etc.
These major health and allied reforms, if implemented effectively, have the power to transform health systems over the next 30 years. Synergistic partnerships between public and private health systems with governments’ stewardship over the private sector will build upon the growth story of health systems post-economic liberalization achieved over the last 30 years. By 2050, all people should have a free choice of their provider, full access to health and care when, where, and how they need, and full control over their health data. Their right to privacy should be fully protected while handling their sensitive health data. No one should be left behind in accessing safe and effective care on account of socio-economic, geographic, gender, literacy, and digital divide.
Dr Krishna Reddy Nallamalla
Country Director, ACCESS Health International