By Arushi Sharma
A new Private Member Bill introduced in the Rajya Sabha seeks to make Right to Health a fundamental right in India. For this purpose, the scope of Article 21 will have to be expanded by implementing a constitutional amendment. The bill, proposed by YSR Congress MP Vijaysai Reddy, envisages that all the citizens should be able to avail a health protection system that provides prevention and treatment of diseases as well as access to essential medicines. According to MP Reddy, Providing adequate medical facilities for the people is an obligation of the government in a welfare state.
The need for right to health
According to the Draft National Health Policy, 2015, 63 million people are pushed to poverty every year as they are unable to cover their healthcare costs. The current public expenditure on health, however, stands at only 1.4 percent of the GDP. This year in March, the Centre cleared the National Health Policy 2017 in an effort to increase health spending, gradually and timely, to 2.5 percent of the GDP. The primary aim of the policy was to guarantee healthcare to all Indian citizens, particularly the underprivileged sections, by strengthening the public health system and leveraging strategic public-private partnerships in the health space.
Union Health Minister, J.P. Nadda, referred to the policy as a turn of the national health goals in a direction of wellness from merely sick care. However, as reported by The Hindu, concerns remained around the inadequacy of the GDP spend to cover the vast healthcare challenges faced by the country in the absence of a proper financial protection mechanism. Healthcare activists also argued that the policy put forth an empty promise as it steered clear of making right to health a fundamental right.
Importance of the bill
Private Member Bills have not had the most favourable history in getting a nod from both the Houses of Parliament. Only 14 such bills have been passed and become a law since Independence, the last one being in 1970. Right to Health is an internationally recognised fundamental human right. But the current national health apparatus in India is an out-of-pocket one. Millions of poor patients have access to a doctor only if they can pay the bill at the time of treatment or if they are sick enough to be admitted to a public hospitals emergency ward. If Article 21B is introduced in the Indian Constitution, the failure to provide health care will have legal consequences. Moving forward, India should look to evolve its healthcare system beyond the current assurance-based approach.
Choosing the right model
India can choose from a number of different models, learning from the rest of the world. One such model is that of total governmental control, referred to as the Beveridge model. The government uses its revenue to finance universal coverage, just like the public library or the police force. Such a system benefits from low per-capita costs as it allows the government to regulate and negotiate prices of drugs and medical services. Cuba has possibly the purest application of this model, enabling the country to eliminate the need for an insurance bureaucracy. Other examples and versions of this kind of single-player model exist in the UK, Spain, and New Zealand. In a Beveridge-style healthcare, most of the hospitals and clinics are government-owned and even the private doctors collect their fee from the government.
Some countries also have an insurance-based healthcare system, wherein health insurance plans cover all the citizens and the insurers do not make a profit out of it. Known as the Bismarck model, this system is jointly funded by employers and employees via payroll deduction. Countries like Germany, France, Belgium, Switzerland, the Netherlands, and Japan, among others, have Bismarck-type health plans. The United States has a peculiar for-profit health insurance system.
Another option is to adopt a National Health Insurance (NHI) model, which has been adopted in Canada, Taiwan, and South Korea. The NHI combines the first two models, using private-sector providers but financing through a government-run insurance program. Every citizen pays into the corpus and there is no profit or financial motive. The NHI finds an exemplary representative in the Canadian government, who has negotiated low-price medicines for its citizens from pharmaceutical companies. Cost control is exercised by limiting the government-covered medical services or by putting patients up on a wait-listed treatment roster. Therefore, considering that the existing system in India does not guarantee every citizens well-being in the real sense, evaluating the practicality of different healthcare models in the Indian context would be a good place to start.
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