India needs 10-15 years to roll out universal health plan: KPMG
India will struggle to become a global superpower without an efficient healthcare system, and would need 10 to 15 years to cover everyone under its ambitious universal health coverage programme, KPMG’s global health chief said.
Under the National Health Assurance Mission, Prime Minister Narendra Modi’s government would provide all citizens with free drugs and diagnostic treatment, as well as insurance cover to treat serious ailments.
Mark Britnell, chairman of global health practice at consultants KPMG, said he was optimistic about the future of India’s health system, but the country’s overall spending on healthcare needs to rise to about 6 percent of its gross domestic product within the next decade from the current 4 percent.
“If India does not treat its people with respect in healthcare, it will struggle to become a global powerhouse,” Britnell said during an interaction with Reuters, where he spoke on a range of topics including primary care and corruption in the sector. Below are edited excerpts:
Q: Why do you think India has neglected healthcare as a sector?
A: The sheer size of the population and its disbursement make any attempt on a national policy difficult. Even if you were highly motivated, the prospect of implementations across so many people is difficult. But the answer is (lack of) political will. India has been too preoccupied in pursuing economic growth. But there comes a point when you think about the societal consequences and sustainability of growth. There is such great expectation of hope in Modi that something should be done now, and it’s about time.
Q: Do you think India can become a world leader without having a great healthcare sector?
A: You can’t be a global powerhouse if your average life expectancy is 66 years of age. If you want a sustainable economy which is world-class, you need a sustainable universal healthcare system.
Q: India this year cut its health spending by about 20 percent. Bureaucrats, experts and the government cite under–utilisation of funds and fiscal strains as reasons. What do you think?
A: I can’t comment directly, but both stories are likely to be true, and both are potentially toxic ingredients when you are trying to launch universal healthcare because you need security of financing sources. You also need great capability in your civil servants and your managerial class.
Q: What about primary health services, which many say the government is in the best position provide to the masses?
A: Broadly speaking, it is true that the public sector can provide primary care at scale more easily than the private sector. In rural areas it’s absolutely right, but in urban areas where you need a combination of diagnostic capability and capacity in primary care, I would be more agnostic about who provides it and have more of public-private ventures.
Q: How is corruption affecting India’s health sector?
A: Corruption is corrosive and it’s cancerous in terms of business investment and trust. Over the last 2-3 days, this issue has been raised on different occasions. It’s a real concern, whether it’s through pharma companies or medical device companies, or, I am ashamed to say, through medical professionals. This is all inflating prices and denying services to people.
Q: What would be your advice to Modi on how to fix India’s public healthcare system?
A: I would tell him three things – (1) Well done Mr. Modi for creating the political will for universal healthcare (2) You now need to take a 10-15 year view on the proceeds of growth through your economic performance, so you need a long-term view on health funding (3) You should not make an aspirational offer, but a realistic offer to your people about what UHC (universal health coverage) can offer. I would tell him to be more agnostic, whether the public or private sector provides it. I don’t believe India is in a position to be so dogmatic about where this comes from.
Q: How long will India take to implement UHC? India plans to roll it out completely between 2015 and 2019. Do you think that is realistic?
A: It would be a world first. International experience would say it takes between 10 to 15 years to stand up a sustainable universal healthcare system. I think India will take that much time.
Q: Can you mention a few countries whose health systems India can learn from?
A: One would be Japan. If you look at the way they created their UHC system in the 1950s/60s, it is a very good model to look at. Another is Brazil. In 1988, they made healthcare a universal right. They showed the requisite political will and they created a very broad community in primary care system which is still standing today.