Don’t take the wrong pill- Universal Health Coverage


 

 

 

Editorial, The Hindu 

 


The Planning Commission must not make the mistake of letting short-term fiscal concerns overturn the national aspiration for Universal Health Coverage (UHC). Some elements of the draft Twelfth Plan on health have caused alarm, as they run counter to key recommendations of the Commission’s own High Level Expert Group. The Plan panel wants to reduce out-of-pocket spending on health from 71 per cent to 50 per cent during the Plan period, to mitigate the biggest factor that leads to impoverishment of many families. But that will be impossible without substantial fiscal support. Regrettably, there appears to be a quiet attempt to peg targeted public spending on health at 1.58 per cent of GDP, ignoring the HLEG recommendation for an increase to 2.5 per cent over five years, and to 3 per cent by 2022. Among comparable nations, India brings up the rear in public spending on health at 1.2 per cent of GDP.

 

English: Manmohan Singh, current prime ministe...

English: Manmohan Singh, current prime minister of India. (Photo credit: Wikipedia)

 

It is now crucial for the Centre and the States to come together and launch a UHC model funded by general taxation that meets the essential health requirements of all people. The success of legal reform in the United States to regulate a socially disconnected, for-profit health industry, and the remarkable equity achieved by other welfare-oriented countries should persuade Indian leaders on launching a national plan.

At the polio summit in February, Prime Minister Manmohan Singh emphasised the need to strengthen public health systems, and accelerate efforts to achieve universal access to care. It would defeat this idea if UHC were to rely on for-profit providers of care and insurance under a ‘managed care’ model. The Planning Commission would do well to steer away from the siren songs of corporatisation, and focus on the core challenge: the need to set up an independent regulatory framework at the national and State level for all types of care institutions, regulate drugs to lower costs and promote generics, identify standard treatment and management guidelines, and provide resources to fund the essential health package. It is of course encouraging that the Commission has distanced itself from reports of reliance on corporate providers, but it is essential to state the vision clearly in the Plan. Also worth pointing out is the potential of UHC to create a large number of jobs and spur economic growth. India needs many more professionals to achieve the ideal norm of one doctor for 1,000 people, and three nurses and midwives per doctor. Here, the HLEG provides a useful roadmap for expansion of teaching institutions, which can quickly raise the capacity of many remote hospitals.

 

 

 

Immediate Release-Planning Commission of India to hand over Health Care to Corporate Sector


 

English: Montek S. Ahluwalia, Deputy Chairman,...

English: Montek S. Ahluwalia, Deputy Chairman, Planning Commission, India, speaks at the closing plenary of the World Economic Forum’s India Economic Summit 2008 in New Delhi, 16-18 November 2008 (Photo credit: Wikipedia)

 

 

 

 PRESS STATEMENT

 

 

Planning Commission of India to hand over Health Care to Corporate Sector

 

The draft health chapter of the 12the Five Year Plan document is being discussed for final adoption by the Planning Commission by the end of August, 2012. The Jan Swasthya Abhiyan (Peoples Health Movement – India) expresses concern regarding the present recommendations and plans outlined in the draft chapter. The chapter fails to build on the recommendations of the High Level Expert Group (HLEG) set up by the Planning Commission, misquotes the Group’s recommendations in many places and ends by proposing a plan for restructuring the country’s health system that would effectively hand over health care to the corporate sector. It is particularly problematic that the plan document invokes the concept of Universal Health Care, while actually proposing a strategy that is far removed from the basic tenets of Universal Health Care.

 

The Plan document recommends increase in public expenditure on health from the present 1% to 1.58% of GDP. This is in sharp contrast to the HLEG recommendation of increasing this expenditure to at least 2.5% of the GDP and also at variance with the earlier pronouncements by the Prime Minister. Secondly it proposes that the Central government’s (which collects most of the taxes ) share in the additional health expenditure would be less than half of what states would contribute and that Centre’s contribution would be conditional on states’ contribution!   The Planning Commission seems to have decided thatIndia will continue to be among the bottom 10 nations in terms of percent GDP spending on health.

 

What is of even greater concern is the strategy proposed for restructuring of the country’s health system in the document. The Plan document proposes a transition from: “….the present system which is a mixture of public sector service provision plus insurance, to a system of health care delivered by a managed network”. There is, thus, a road map envisaged where the Government will abandon its central role of providing health care and become primarily just a ‘manager’ of the new system envisaged.

 

The document’s vision of ‘universal provision of public health care’ includes two components.  “..preventive interventions which the government would be both funding and universally providing” (see annexure) and  “clinical services at different levels, defined in an Essential Health Package, which the government would finance but not necessarily directly provide”. What, in essence, this formulation proposes is that the Government would, over time, confine itself to providing a small package of services and would be primarily just a purchaser of virtually all clinical services from the  corporatised private sector. The Government would thus finance (with public money), strengthen and bolster an already resurgent corporate sector providing medical services. On the face of it, this appears an almost diabolical ploy to hand over the profit-making clinical services sector to corporate hospital chains. It would also decisively halt and eventually reverse the moderate achievements of the National Rural Health Mission, in expanding public health infrastructure and services in parts of the country.

 

The public health system will now be asked to compete with the private sector to attract patients. A system is envisaged where: “each citizen family would be entitled to an Essential Health package in the network of their choice. Besides public facility networks organized .. private and NGO providers would also be empanelled to give a choice to the families”. Even this truncated role of the public system is qualified by the proviso that” “..public facilities will have to be strengthened, networked, and their managers provided sufficient autonomy to purchase goods and services to fill gaps as per need”. In other words, public only in name, but would be vitiated by the logic of the market and by the incorporation of private players into its fold.

 

The HLEG had, in its report, commented that: “since there is virtually no focus on primary level curative, preventive, and promotiveservices and on long-term wellness outcomes, these traditional insurance schemes often lead to inferior health outcomes and high health care cost inflation”. Yet the Planning Commission’s document repeatedly talks about expansion of the health insurance scheme called RSBY and its vision of Universal Health Care is nothing but a more expanded version of the RSBY scheme.

 

The document announces another bonanza to the corporate medical sector in the form of grants to set up hospitals and private medical colleges. It says: “Health has now been included with other infrastructure sectors which are eligible for Viability Gap Funding up to a ceiling of 20% of total project costs under a PPP scheme. As a result, private sector would be able to propose and commission projects in the health sector, such as hospitals and medical colleges outside metropolitan areas, which are not remunerative per-se, and claim up to 20% of the project cost as grant from the Government”. It may be noted that the only eligibility requirement is the location, and not any contribution to public health goals.

 

This document proposes that  public health facilities will have “flexibility” to raise their own finances. The Plan document says: “Tertiary care facilities would have an incentive to generate revenues if they are provided an autonomous governance structure, which allows them flexibility in the utilization of self-generated resources within broad policy parameters laid down by the Government”. There are several ways in which such flexibilities can be misused, including in the form of levying of user charges and arrangements with private entities that seek to extract benefits that conflict with the public health goals of public institutions.

 

The HLEG  had recommended : “enforcement of price controls and price regulation on essential and commonly prescribed drugs”. However, this document does not even  mention drug price regulation, in spite of a pending Supreme Court directive that the Government should expeditiously put in place a system to control the prices of drugs. Neither is the recommendation of the Expert  Group, that the production of drugs and vaccines in the public sector be incentivised, reflected anywhere in this  Planning Commission’s chapter.

 

The ideological bias of the Planning Commission’s report is clear when it says: “A pure public sector delivery system involves funding a large public sector health system, with little incentive for the service providers to deliver a quality product”Such an assertion flies in the face of global evidence that the best performing health systems are those that are publicly financed and where health care is provided either almost entirely by the public sector or by a combination of the public sector and non-corporate  providers. Neighbouring Sri Lanka has been long held as an example of such a system, where over 90% of in-patient care and over 50% of out-patient care is provided by the public sector. Mortality and morbidity rates in Sri Lanka are far better than in India, in spite of the country having a lower per-capita GNP. Thailand, in recent years, has made rapid strides in providing universal access to health services by increasing public finances and by significantly expanding public provisioning of health services. In contrast, the United States, provides ‘choice’ between public and private providers but is by far the worst performing health system among all developed countries, in spite of spending over 8% of GDP on health care.

 

The Planning Commission’s recommendations, perhaps make some sense if seen purely in the context of neoliberal economic policies. Injection of public funds into a floundering economy through the financing of the private, corporate controlled, hospital sector may seem attractive in such a context. But the strategy is disastrous in public health terms, and is designed to finish of the vestiges of a public health system that still survives in the country.

 

 

 

Plan panel wants govt to retreat from healthcare #Goodnews


 

Nitin Sethi & Kounteya Sinha, TNN | Aug 8, 2012, 02.17AM IST

NEW DELHI: In a move that has angered the health ministry, the Planning Commission has asked for reversal of the long-standing public health policy from the 12th plan onwards ending governments’ dominant role in providing health services and transiting to greater privatization of the health sector, something along the lines of the ‘managed care’ system which is followed in the USand Mexico.The health ministry has taken a tough stance against what is referred to as “corporatization of health care” and will send a strong reply on Wednesday to plan panel deputy chairman Montek Singh Ahluwalia arguing that “the first priority should be to strengthen the public health system and involve the private sector only for critical gap filling”.

The letter from health minister Ghulam Nabi Azad says that “the private sector should not substitute but actually supplement the public sector”.

TOI accessed a draft, finalized at the end of July, of the 12th five year plan‘s health chapter which sketches the dramatic policy reversal that would bring in universal health insurance coverage by allowing a selected ‘network’ of private and other operators to sell their services on competitive basis to the government for which they would be paid on what the health industry calls ‘capitation’ basis or simply on fixed rates for different treatments for every person handled.

The plan panel’s prescription visualizes government’s role in delivering primary healthcare as restricted to mere essentials like antenatal care, leaving more lucrative medical treatment to the ‘managed-care’ system where private players will compete with cash-strapped government-run hospitals to run the ‘networks’.

The commission’s proposal runs contrary to what even its High Level Expert Group (HLEG) on health reforms had said as recently as November 2011.

The HLEG, headed by Dr K Srinath Reddy, had recommended, “Purchases of all healthcare services under the universal healthcare system should be undertaken either directly by the central and state governments through their departments of health or by quasi-governmental autonomous agencies established for the purpose.”

In other words, the HLEG recommended that health delivery services should be run by the government and where a need arises, the government can hire private hospitals for which they would be paid on fixed basis. Under this system, the private players would not be competing but filling the gap.

The HLEG went against the ‘managed care’ system that the Planning Commission has now recommended.

“It becomes necessary, therefore, to either explore a completely different approach towards the use of insurance companies and independent agents – more in the ‘managed care’ framework, where they take on explicit population level health outcome responsibilities or invest further in the capacity of the ministries and departments of health to directly provide and purchase services from contracted-in private providers wherever necessary. We favour the latter option,” the expert group had held.

HLEG will meet on Thursday to discuss the commission’s latest proposal.

Dr Reddy told TOI, “We have clearly voted for strengthening of the public sector. We will meet on Thursday to discuss where there is a mismatch between our recommendations and the commission’s proposal.”

He added, “We have clearly said that the public sector needs to be strengthened and should be the main provider of services under the UHC. Where needed, the private healthcare provider could be contracted to supplement these services through a well designed system. Both public and private providers should be monitored by an independent regulator for quality of care so that the entitlement under the UHC is properly delivered through technically competent and ethically correct health care.”

The health ministry, however, is livid. An official told TOI, “We should not forget the exploitation of patients that goes on in the private sector every day through over prescription and over diagnosis. The health challenges in India‘s urban and rural areas are completely different. The private hospital chains have no presence in such backward areas facing the worst health indicators. How will they perform there?”

The ministry is also worried that such a move by the Planning Commission will take away “the few doctors that are still practicing in public hospitals”.

“The National Rural Health Mission needs to be continued. We have invested huge amount of money and planning over the last seven years over it and are finally seeing results. A National Urban Health Mission needs to be floated for the urban poor,” the ministry said.

Sources said at stake in this controversial move is the health sector pie which is set to rise substantially as the government ups its investment in the 12th five year plan to Rs 10,85,369 crore.

At present, almost all health funds provided to states are part of the flexible arrangement to help states set public health priorities.

The Planning Commission has recommended that this be kept to a minimum of 10% of the total funds and the rest be part of an ‘incentive fund’ which will be linked to the state governments undertaking such ‘reforms’ and other targets. This would also effectively reduce the funds that the health ministry controls substantially.

Oddly, the Planning Commission’s report even misinterprets what the HLEG recommended and claims, “The expert group has recommended that we should move towards a system of a network of health service providers at the primary, secondary and tertiary level which is funded on the basis of per capita payment to the network. The system managed as a network of service providers and individuals is registered on payment of a charge per person covered. Once enrolled, the individual’s health problems are handled by the network as a whole, with proper regard to the need for preventive care and a sequence of care from primary to the higher level as needed.”

Times View

India’s healthcare system is already among the most privatised in the world and the last thing we need is a further retreat of the state in this sector.Far from reducing its role, the government should be focussing on increasing it.

Not only does it need to spend much more on building infrastructure like hospitals and primary health centres, it must ensure that these are adequately staffed and equipped.Of course, ensuring that the money spent is well-utilised is important, which also means constant monitoring of whether doctors and paramedical staff are actually present where they are supposed to be.

The immunisation programme too needs to boosted and urgently. These are not options but necessary steps because, like education, healthcare too must be seen as something all citizens are entitled to.

 

Ministry opposes plan to overhaul healthcare #Goodnews


The ministry has asked Planning Commission to rewrite its chapter on health in the 12th 5-year Plan document

Vidya Krishnan

New Delhi: The health ministry has opposed the Planning Commission’s proposal for a radical overhaul of the public healthcare system, saying it deviates from the government’s primary goal of providing health coverage to all.

The ministry has asked the apex planning body to rewrite its chapter on health in the 12th five-year Plan document that covers FY12-17, a top ministry official said, asking not to be identified.

 

Voicing opposition: Health secretary P.K. Pradhan (PIB)

Voicing opposition: Health secretary P.K. Pradhan (PIB)

 

Several of the commission’s suggestions contradict recommendations of the high level expert group (HLEG) on universal health coverage, or UHC, set up by Prime Minister Manmohan Singhin October 2010 with the mandate of developing a framework on affordable healthcare for Indians, this official said. The bone of contention is the Planning Commission’s proposal to switch to a “managed healthcare network” model in which public and private hospitals may have to compete with each other for patients. 

Also, under the plan, the government’s primary healthcare function will be limited to essential interventions such as immunization, antenatal care and disease-control programmes, leaving clinical services to the managed-care model. The government’s role will in effect diminish from providing health services to managing the network.

Under the managed-care model, while networks of largely private hospitals will be paid per patient registered, doctors will be paid per prescription, according to the Plan document. The transition to this model is proposed to happen over two Plan periods (2012-17 and 2017-22).

“We have to learn from the Chinese experience where reform led to creating of public doctors with a private mindset. China is now revising its health policy because of growing inequity,” said Dr. Srinath Reddy, who headed the HLEG.

“We have to ensure the public sector remains committed to providing quality healthcare without chasing money in any and every manner. We need to develop a model of UHC wherein the private sector will assist the public sector in serving a public purpose rather than privatising the delivery of public sector healthcare,” he added.

HLEG members will meet on Thursday to discuss the health plan and will give their feedback to Montek Singh Ahluwalia, deputy chairman of the Planning Commission.

The health ministry will within 10 days send its feedback strongly advising the Planning Commission to rewrite certain aspects of the health chapter, said health secretary P.K. Pradhan, who was also a member of the HLEG that drafted the report on providing UHC in India.

“Our main objective is to strengthen the public health sector. At this juncture, we are convinced that a network-based approach will be very difficult to achieve that objective,” he said.

“Having read both documents, I know that some of the strategies made in the plan document are far removed from the basic tenets proposed by HLEG,” said Abhay Shukla, public health activist with Jan Swasthya Abhiyan, a non-governmental organization.

“The Plan document gives two scenarios of India’s public health reforms. Either the public health system should start behaving like the private sector, with performance-based remuneration, etc., or it should compete with the private sector and reshape itself in the image of the private sector to compete effectively,” Shukla said. “In both cases, privatization and coporatization of healthcare in India appear as the dominant direction. They (Planning Commission) are using HLEG’s name to push these recommendations.”

The Plan document also proposes a significant expansion of publicly funded insurance schemes such as the Rashtriya Swasthya Bima Yojana to provide universal health coverage whereas the HLEG had recommended strengthening public sector hospitals instead of using the insurance route to provide health services.

vidya.krishnan@livemint.co

Health versus wealth


Poornima Joshi, Hindu  Jul 26, 2012

Health issue:The packaged care model may not work as it deters an integrated health system.

Health issue:The packaged care model may not work as it deters an integrated health system.

Current deliberations in the Planning Commission about actualizing universal health care in the Twelfth Five Year Plan, have invited concerns. There has been a marked thrust on state-funded insurance as opposed to a genuine effort on the government’s part to rebuild public health systems, something that has been a globally time-tested system to ensure health for all.

The ongoing discussions are based on reports of the Planning Commission’s steering committee and High Level Expert Group (HLEG). The contentious theme in the definition of the Universal Health Care (UHC) coined by HLEG, excluding the promise of ensuring “affordable, accountable, appropriate health services of assured quality to all Indians”, states the role of government as a “guarantor and enabler” and not necessarily the “only provider” of health and related services.

The HLEG makes two critical recommendations that have raised objections from health experts and activists alike. A crucial recommendation that is being contested is the “purchase” of insurance schemes by the government. “Purchase of all health care services under the UHC system should be undertaken either directly by the central and state governments through their departments of health or by quasi-governmental autonomous agencies established for the purpose,” says the HLEG report. The other contentious suggestion is the proposed “contracting in” of the private sector. “Develop effective contracting-in guidelines with adequate checks and balances for the provision of health care by the formal private sector,” HLEG report adds.

At a seminar organized by the Council for Social Development in the Capital in July, health experts opposed this proposed roadmap towards UHC even when there was near unanimous approval of the proposal to raise health expenditure from the abysmally low, that is, 1.2 per cent of the GDP, to at least 2.5 per cent of the GDP by the end of the Twelfth Plan, and to at least 3 per cent of GDP by 2022.

According to Prof. Imrana Qadeer, formerly of the Centre of Social Medicine and Community Health (CSMCH) in JNU, improvement of health care has to be accompanied by enhancing the efficiency of public sector. “There is a need to go back to the Bhore committee and delve into economic and social structures in the country to if access to health care has to be universalised. We have to talk of equality not equity. The steering committee separates health from health services,” said Prof. Qadeer. “What do terms such as ‘contracting-in’ of the private sector mean when the corporate sector is actually leading reforms in the health sector?”

The HLEG envisages a “managed care” model with a thrust on an increase in government expenditure. By increasing public spending on drug procurement, availability of free essential medicines is to be ensured. General taxation, as per HLEG, is the principal source of health care financing – complemented by additional mandatory deductions for health care from salaried individuals and tax payers. It proposes introduction of specific purpose transfers to equalize the levels of per capita public spending on health across different states level of essential health care. Most importantly, the HLEG proposes universal and cashless access to an Essential Health Package (EHP) including essential medicines.

These ideas are further consolidated in the steering committee of the Planning Commission. “To begin with, core components of the EHP must include all the preventive, promotive, curative and rehabilitatory services in routine and emergency settings available under RCH and national health programmes,” says the steering committee report.

There are problems with this “packaged care” model, pointed out Dr Amit Sengupta of the Delhi Science Forum (DSF). How do you spend the money—do you use it to build a system or use it to provide UHC as a package? Who provides health care is important because fragmented provisioning of services does not allow for development of integrated health systems.

“Advancing the logic of fragmentation, an attempt is made to promote segregation of health systems into primary care by the public sector and tertiary care by the private sector. As the private sector grows to fill the vacuum, a loud noise is made about ‘catastrophic payments’. The state then steps in and asserts that a ‘minimum package’ would be ensured. The argument for this is lopsided because private sector, despite being a ‘partner’ in providing tertiary care, is then financed through public funds, that is, through ‘minimum packages’ ensured by the state,” said Dr Sengupta.

There is enough evidence, said Dr Sengupta, to prove that the best performing systems are those that are publicly financed and provisioned. “Public provisioning needs to be located in a range of other social protection measures while public financing has to be located in a progressive taxation system that is premised on the notion of equity.” Clearly, it will take far more than insurance packages to ensure health for all. Time-tested global models in Cuba, Costa Rica and neighbouring Sri Lanka prove that the government has to necessarily be the “provider” and not just a “guarantor” to actualize universal health care.

The Planning Commission’s perspective on universal health care causes concern

Immediate Release-Jan Swasthya Abhiyan Calls For National Debate for ‘Universal Health Care’


Press Statement on the occasion of World Health Day – April 7th 2012

Jan Swasthya Abhiyan Calls For National Debate On Design Of Proposed System For ‘Universal Health Care’

Ensure quality, free health care for all as a right: Give priority to expansion and improvement of Public health services, regulate Private medical sector

Over the past year there has been a lot of interest in and visibility of the concept of Universal Health Care. The Planning commission had set up the High Level Expert Group (HLEG) on Universal Health Care (UHC) which has submitted its recommendations in Nov. 2011. The Planning Commission is now considering implementation of Universal health care in some form during the XIIth Five year plan. JSA welcomes this interest and commitment to Health care for All by the Government of India. On the occasion of 7th April, 2012 World Health Day, JSA would like to set out clearly our views on the issue as well as express serious concern with the direction in which the discourse on Universal Health Care seems to be taking.

THE HLEG AND PLANNING COMMISSION STEERING COMMITTEE REPORTS

The JSA welcomes a number of key aspects of the HLEG-UHC report. Most importantly we appreciate:

 The emphasis on the concept of “universal”, of including every citizen, unlike the currently dominant approach of “selective” approach of targeting the poor

 Clear emphasis on tax-based financing of the health system, rejection of insurance in the financing and provisioning of universal health care.

 Recommendation to abolish user fees in the health system.

 Definite commitment to “Free Medicines for ALL” in the Public Health System.

 Recommendation of strengthening and the expanding the public sector

 Recommendation to establish Urban UHC system.

Defining the need and urgency of private sector regulation, as well as outlining a potential regulatory structure.

 Bringing Community based accountability mechanisms to the center stage.

More recently the Steering Group on Health of the Planning commission finalized its report which incorporates (interprets) the findings of the HLEG into the Planning Commission process. However the Steering committee report contains recommendations that would defeat the purpose and spirit behind any evolving process of Universal Health Care.

 The reduction of the comprehensive Essential Health Package suggested by the HLEG into just RCH and National Health Programes. This is NOT a Universal health care entitlement.

 The concept of giving financial and operational autonomy of the public health facilities is also very problematic. Financial autonomy means leaving the public health system to “fend for themselves”. This will be very damaging to any hopes for a Universal System.

 The concept of “provider choice” to choose between private and public providers is also unacceptable. Especially during last 20 years, the public health system has been neglected and made sick whereas the private sector has received encouragement for un regulated growth.

 JSA believes that the private sector should play a complementary / supplementary role, on the terms defined by a strengthened public health system accountable to the people.

 Steering Committee report suggests that one district in each state pilot this concept in the first year of the plan. We would strongly suggest that the unit of pilot should logically be the state, and more over that such pilots be initiated only after full discussion and public debate.

JSA’s VISION FOR A UNIVERSAL HEALTH CARE SYSTEM

We firmly believe that the public health system has to be the back bone of any universal health system. Our emphasis should be on strengthening of the Public Health system, especially the primary level of care. The public sector should be brought up to its full functional capacity and expanded.

The private sector needs to be involved in the UHC system only on the terms of public good. Integration of the public and private sector is to be seen in terms of an integration of the “logic” of the health system. Corporate profits should not be allowed to lead or define health provision. The health system has to be effectively and transparently regulated with its primary goal being the people’s welfare rather than private profit. It is only under such circumstances that we can develop a UHC system that will truly serve the needs of the people equitably.

UHC system should be based on tax based financing. Present models of publicly financed commercial insurance (such as Arogyasri scheme in Andhra Pradesh) have proved to be highly problematic in terms of scope and rationality of care, and become financial drain on the exchequer without delivering anything like Universal health care.

The governance of the whole UHC system must be firmly people centered and rights based, with a community led and focused process. We visualize institutionalizing a process of community based monitoring, planning and action for health which is evolved based on experiences in a number of states of the country in which JSA partners are involved.

Jan Swasthya Abhiyan call for action on Universal Health care

Given this situation the JSA calls for the following:

 A national public debate on the contours of the proposed universal health care system. Such an important issue cannot be rushed through and its various strands need to be understood, discussed and commented upon widely by the people.

 Definition of a clear, transparent and time bound road map for strengthening and expanding the public health system while improving its functioning and accountability; this must include allocation of adequate, enhanced budgets.

 Enactment of adequate laws guaranteeing the right to health, including National and State Health acts, which would lay down the framework for regulation of the health system, particularly relevant for private medical providers. Providing entitlements must be accompanied by a clear framework for accountability and grievance redressal.

 While developing and operationalising the universal health care system, highest priority must be given to significant expansion and improvement of public health services. Regulated private providers should not be competing with public providers for common resources, rather they may be in-sourced to provide services, but never as a substitute to the public sector.

 Ensuring forums for participation of community members, community based groups and civil society organizations along with elected representatives and public health functionaries at various levels, for planning, monitoring and reviewing the functioning of the universal health care system.

We must be aware that the direction of developing universal health care in India must be towards strengthening the public health system and socialization of health care, rather than promoting further expansion of unregulated, profit-oriented private medical care. Hence a national debate is essential and there should be no haste in rolling out these concepts – even the looming large of the General elections should not become an excuse for the government to short circuit and distort the concept of Universal Health Care for narrow political gains.

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