Priorities are changing, people are more aware of the health insurance, health laws and personal wellbeing in particular.
The Union Cabinet chaired by the Prime Minister Shri Narendra Modi in its meeting on 15.3.2017, has approved the National Health Policy, 2017 (NHP, 2017). Prime Minister Shri Narendra Modi called it a “historic moment…to create a healthy India where everyone has access to quality healthcare”. The primary aim of the National Health Policy, 2017, is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions – investments in health, organization of healthcare services, prevention of diseases and promotion of good health through cross sectoral actions, access to technologies, developing human resources, encouraging medical pluralism, building knowledge base, developing better financial protection strategies, strengthening regulation and health assurance.
Now after the last 15 years context has changed. First, the health prorities are changing, people are more aware of the health insurance, health laws and personal wellbeing in particular. Second important change is the tremendous growth of the healthcare industry, according to IBEF ‘The overall Indian healthcare market is worth around US$ 100 billion (as of 2017) and is expected to grow to US$ 280 billion by 2020, a Compound Annual Growth Rate (CAGR) of 22.9 per cent. Healthcare delivery, which includes hospitals, nursing homes and diagnostics centres, and pharmaceuticals, constitutes 65 per cent of the overall market. The Healthcare Information Technology (IT) market which is valued at US$ 1 billion currently is expected to grow 1.5 times by 2020.’ The third major change is the catastrophic increase in the out of pocket expense on health services, which according to some is one of the biggest reason for transient poverty.
On the background of these realities, The National Health Policy 2017 seeks to reach everyone in a comprehensive integrated way to move towards wellness. It aims at achieving universal health coverage and delivering quality health care services to all at affordable cost.
The National Health Policy 2017, aims to attain the highest professional standards, integrity and ethics to be maintained in the entire healthcare delivery system, which would be supported by a transparent and responsible regulatory mechanism. Policy also aims to reduce inequity which would mean minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers.
This would imply greater investment in health care sector and increased financial protection of poor who suffer from the huge burgden of out of pocket expense. The policy is designed in a way to increase affordability, universality and accountabilty in the healthcare system. It also aims to increase transparency and eliminate corruption in the healthcare sector, both in public and private.
The policy seeks to move away from sick-care to wellness, with a thrust on prevention and health promotion. Which is although not unusual but new to India when it comes to healthcare laws. With the main aim of achiving good health and well being through preventive care, NHP2017 have some very ambitious targets – of reducing under 5 motality rate to 23 by 2025, reducing maternal motality ratio from current rate to 100 by 2020, reducing infant motality rate to 28 by 2019. Policy also proposes to raise public health expenditure to 2.5% of GDP by 2025 and increase life expectancy at birth from 67.5 to 70 by 2025. It also aims to reduce Total Fertility Rate (TFR) to 2.1 by 2025 and increase the availability of beds to 2 per
1000 population in golden time period or within one hour of the injury. What is uniques about the NHP2017 is that it aims to achieve its objectives through deployment of digital tools for improving efficiency and outcomes of healthcare systems. It also recommends the establishment of National Digital Health Authority (NDHA) to regulate, develop and deploy digital health.
Legal Framework for Health Care and Health Pathway
One of the fundamental policy questions being raised in recent years is whether to pass a health rights bill making health a fundamental right- in the way that was done for education. The policy question is whether we have reached the level of economic and health systems development so as to make this a justiciable right- implying that its denial is an offense. Questions that need to be addressed are manifold, namely, (a) whether when health care is a State subject, is it desirable or useful to make a Central law, (b) whether such a law should mainly focus on the enforcement of public health standards on water, sanitation, food
safety, air pollution etc, or whether it should focus on health rights- access to health care and quality of health care – i.e whether focus should be on what the State enforces on citizens or on what the citizen demands of the State? Right to healthcare covers a wide canvas, encompassing issues of preventive, curative, rehabilitative and palliative healthcare across rural and urban areas, infrastructure availability, health human resource availability, as also issues extending beyond health sector into the domain of poverty, equity, literacy, sanitation, nutrition, drinking water availability, etc. Excellent health care system needs to be in place to ensure effective implementation of the health rights at the grassroots level. Right to health cannot be perceived unless the basic health infrastructure like doctor-patient ratio, patient-bed ratio, nurses-patient ratio, etc are near or above threshold levels and uniformly spread-out across the geographical frontiers of the country. Further, the procedural guidelines, common regulatory platform for public and private sector, standard treatment protocols, etc need to be put in place. Accordingly, the management, administrative and overall governance structure in the health system needs to be overhauled. Additionally, the responsibilities and liabilities of the providers, insurers, clients, regulators and Government in administering the right to health need to be clearly spelt out. The policy while supporting the need for moving in the direction of a rights based approach to healthcare is conscious of the fact that threshold levels of finances and infrastructure is a precondition for an enabling environment, to ensure that the poorest of the poor stand to gain the maximum and are not embroiled in legalities. The policy therefore advocates a progressively incremental assurance based approach, with assured funding to create an enabling environment for realizing health care as a right in the future.
Implementation Framework and Way Forward
A policy is only as good as its implementation. The National Health Policy envisages that an implementation framework be put in place to deliver on these policy commitments. Such an implementation framework would provide a roadmap with clear deliverables and milestones to achieve the goals of the policy.