Primary care centres key to reforming healthcare in India: health economist Kenneth Thorpe

April 30, 2015

Over 60 percent of deaths in India are due to non-communicable diseases (NCDs) such as cancer, diabetes, chronic respiratory diseases and cardiovascular disease, which are also responsible for about 70 percent of spending on healthcare. They also affect the economic health of the country, with NCDs and mental illness expected to cost India $4.58 trillion between 2012 and 2030.

Health economist Dr. Kenneth E. Thorpe, chairman of Partnership to Fight Chronic Disease, an international NGO, is advising the government of India on developing a policy to deal with the country’s rising chronic disease problem.

In an interview with India Insight, Thorpe shared his thoughts on how India can reform its healthcare delivery system, the need to replicate successful models of primary health centres to cover the entire country, and why payments for health services need to be changed from out-of-pocket expenses to a subscription-based system and through insurance.

Q: Why should India focus on non-communicable diseases (NCDs)?
A: NCDs account for over 60 percent of deaths in India. It’s also a major driver of health spending – 60 to 70 percent of what India spends on healthcare is linked to NCDs. It’s a major problem not just in terms of healthcare but also in terms of productivity.

Q. Which sector is more crucial to improving healthcare delivery in India – government or private?kth
A: Both. It’s got to be a public-private partnership. So today, India spends about 4 percent of its GDP on healthcare. About one-and-a-half percent of that is the government and the rest is private. So we just need to scale that up – probably proportionally to something like 5 or 6 percent of GDP.

Q: In what way are you working with the Indian government?
A: We’re working on developing a policymaking framework for healthcare reform solution for India.

Q. Has there been any progress?
A: With the Modi government coming in, there was a renewed interest in developing something as a health policy solution for India. They seem very receptive to some of the things that we’re talking about in terms of preventing chronic disease and treating patients that have chronic disease.

Q: What have you been able to achieve?
A: We were here in December and the ministers asked us to put together a blueprint of what would a healthcare reform look like. And so we put together some thoughts that they basically incorporated into their blueprint (National Health Policy) in February. That’s like an outline, so the next point is saying: “How do we operationalise this outline?”

Q: What have you proposed in your blueprint?
A: One is that we really need to build up the primary care infrastructure. We need more manpower, more hospital beds, but we really need capacity – building up primary care clinics, primary care models that really deal with identifying chronic disease, preventing it and managing it. And there are some good models that we’ve identified throughout the country that we think we can scale them and replicate them throughout India.

Q: Are you saying that the main focus should be on primary healthcare centres?
A: That’s the biggest challenge. That’s the starting place. We need to build from the ground up.

Q: And majority of scaling up will have to come from the private sector?
A: I think one of our messages is that the government can’t do this alone. It just doesn’t have the resources to really build the system and build the infrastructure. It’s going to need private sector investment as well. So we’re trying to figure out how we can harness some of the private sector money and help build a healthcare delivery system and potentially a bigger healthcare insurance system.

Q: Where does the government come in?
A: The government has to play a role in funding, particularly low-income populations – the poor that live in rural areas, urban poor.

Q: What else?
A: Manpower training, more doctors and nurses …

Q: Can the government help in nudging private players to increase their participation, especially in rural areas?
A: The government’s got to play a leadership role and say: “Here’s where we are going, here’s the plan, here’s the framework, the blueprint. We’ll work with the states in order to implement this.”

But we need to sort of change the way that healthcare services are paid for. So today in India, 60 percent of spending is out of pocket. So we need to change that from out-of-pocket buying to something like a primary care package (subscription) or an insurance product.

Q:  Very few people in India have health insurance, and health policies have a very limited coverage.
A: I think the insurance model needs to be completely changed. Private insurance covers just 2 percent of the population and it covers only in-patient hospital care. And the problem is that most of these chronic diseases need primary care, medications, home community-based services – things that are not covered in current insurance policies.

Q: Where does India stand on the problem of NCDs as compared to other developing countries?
A: The challenge India faces is its ability to manage and deal with it is way below the average because the capacity is not there, the infrastructure is not there, the manpower is not there, the investment is really not there.

(Editing by Robert MacMillan; Follow Robert on Twitter @bobbymacReports and David @davidlms25 This article is website-exclusive and cannot be reproduced without permission)

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Great Q & A
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