Going for universal health coverage
dt.24.11.2017
Karnataka does well to finalise the road map to ensure universal health
coverage
Karnataka’s move to amend the law governing private medical
establishments is a logical step in its plan to provide universal health
coverage in the State. There can be a debate on how individual aspects of
medical services are best regulated, but laying down standards, containing
treatment costs, mandating transparency and creating a binding charter that
empowers patients are all basic components of healthcare reform. The State
government has wisely dropped the clause on imprisonment for medical negligence
in the final draft of the amendment Bill, avoiding a possible delay in
broadening the scope of the Karnataka Private Medical Establishments Act, 2007.
There is a need, of course, to ensure parity in services offered by government
and private institutions, and end the neglect of public facilities especially
in rural areas. The transition to universal health access, provided free at the
point of delivery, must be a national priority as it is the key Sustainable
Development Goal relating to health to be achieved by 2030. The UPA government
dropped the ball midway, although it had a report from an expert group of the
Planning Commission in 2011 proposing a road map for universal coverage.
Karnataka is pursuing needed reform in some of the areas covered by the expert
panel, notably on containing the cost curve in establishments that operate for
profit and where patients with state-supported insurance get treated.
The task before Karnataka now is to come up with an essential health
package consisting of treatments available to all and to devise ways to charge
users based on the ability to pay. Capping costs for those who use such
facilities is important, given that out-of-pocket expenditure on health in
India is extremely high. Regulation of prices for some drugs may have had a
moderating effect, but much work remains to be done to streamline processes to
achieve centralised procurement and free distribution of essential medicines to
all. Karnataka’s decision to set up a regulator for government hospitals is a
response to the criticism that nothing is being done to raise standards in
these institutions and bring in accountability. Ideally, all health
institutions participating in a universal access programme should be governed
by common regulations, for which national, State and district-level authorities
are the answer. Such a comprehensive approach can eliminate fragmentation of
functions. Also, the public health approach at the primary level should not be
lost sight of, while focussing on reform of hospital-based care. National
schemes aimed at reducing the burden of infectious and non-communicable
diseases, and improving the health of women and children, should continue to
receive top priority
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