Written By: Satata Karmakar | Updated : June 13, 2022 12:06 PM IST
India’s Success With Universal Health Insurance Can Be a World Standard If Done Right
India's relationship with healthcare dates back to ancient times, with many forms of Ayurveda and other schools of medicine being practiced. Since independence from the British, when India established its Ministry of Health in 1947, India has strived to create a healthcare system that is accessible to all its citizens. More recently, over the last two decades, India has made tremendous strides toward universal health coverage with the launch of social insurance programs by several states followed by the launch of the Ayushman Bharat National Health Protection Scheme the largest government-sponsored health insurance program in the world.
For a country with a population of over 1.3 billion, accessible and affordable healthcare is both the highest priority and biggest challenge. My prior research shows that providing government-sponsored health insurance coverage, especially to poor families has an important impact on health and financial protection. We found that Karnataka's Vajpayee Arogyashree scheme (VAS) led to a substantial reduction in mortality for covered conditions (almost 58 percent), driven by increased tertiary care utilization as well as better quality of care. Second, VAS provided significant financial risk protection. Third, these benefits of social health insurance were achieved at a reasonable cost to society and taxpayers. Several unique features of VAS led to its success at improving health and financial well-being including effective outreach via health camps, targeting expensive conditions with high disease burden, easy enrolment process, cashless treatment, bundled payment for hospital services, participation of both public and private hospitals and prior authorization to improve appropriateness of care.
Even with all the success of expanding access to health insurance some important challenges remain. The current programs cover only secondary and tertiary care and don't do much to provide access to primary care. My research with my colleagues showed that coverage of primary care is highly cost-effective. For example, coverage of primary care for a cardiac disease alone could add 3.6 million disability-adjusted life-years (DALY) per year at an incremental cost-effectiveness ratio of $469 (INR 36,495) per DALY averted when compared with the status quo of no coverage. Thus, an investment in primary care has a high rate of return in terms of improving health.
Another challenge is the poor quality of care. My work as part of a consensus committee report for the National Academies of Science Engineering and Medicine showed that in low-and middle-income countries, between 5.7 million and 8.4 million deaths occur each year from poor quality of care, more than the death toll of the COVID-19 pandemic. The resulting cost of lost productivity due to poor quality care was estimated to be a staggering $1.5 trillion each year. My research shows that one reason why the quality of care remains poor is that private health care markets suffer from a market failure as patients cannot distinguish between high-quality and poor-quality doctors. As a result the market often doesn't reward high-quality care.
So what are the solutions to twin problems of lack of access to primary care and poor quality care? Investing in telemedicine infrastructure through the creation of a portal can be a big part of solving the problem.
Telemedicine can address the problem of poor access to primary care, especially in villages or remote areas. Doctors are reluctant to live and work in these areas and telemedicine can provide access to care without doctors having to relocate to underserved areas. It is also a more cost-effective solution as it avoids substantial investment in bricks-and-mortar health care facilities. Of course, there will be a need to invest in digitally connecting villages to cities and providing access to tablets or other hardware for telemedicine to community health workers. Telemedicine can also enable more doctors to enter the market and create more jobs. With a telemedicine portal, all doctors need to do is register on the portal with their laptops. Furthermore, telemedicine can improve the quality of care by ensuring that doctors undergo training to show that they have the skills for high-quality care. There is also a way to use the data retrieved from these sources to measure the quality of care and provide the information to citizens using an easy-to-understand star rating system. For example, patient outcomes for different health care providers on the portal can be tracked or a panel of physicians can review patient encounters on the telehealth portal to judge whether the correct diagnosis and treatment were provided. This level of public reporting of quality of care has the potential to improve the functioning of private health care markets by creating market rewards to improve the quality of care.
The future of India's healthcare system is based on universal healthcare and creating a strong infrastructure for it. With India's strength in information technology, we have the potential to create one of a kind tele-healthcare system that provides high-quality healthcare at an affordable price. If done well, it would create the world's largest and most successful network, and be an example for other countries trying to implement universal health care. The next steps are to form a public-private partnership to engage with stakeholders, patients, doctors, and companies in the tech industry to define the critical aspects of the telemedicine portal and launch a pilot project. This would help not only the government and the network of doctors and hospitals but also the patient who is at the core of everything in the system.
(The article has been authored by Neeraj Sood, Ph.D., Professor and Vice Dean for research at the USC Price School of Public Policy)
