Push for health of China
June 27, 2009: The Hindu
‘Health for all’ in a country with 1.33 billion people is a giant challenge. But it also presents a great opportunity, as China is telling the world. Beginning in 2009, central, regional, and local governments in that country will be spending $124 billion as part of a three-year reform plan. This means a doubling of average annual public investment in health over the 2008 level. There are tangible targets in the plan, starting with the provision of medical insurance to 90 per cent of the population. In the cities, such protection will remove the burden of health care costs on urban employees, senior citizens without previous employment, children, university students, migrant workers without stable contracts and their relatives. There will be Medicare schemes for farmers, operating as rural cooperatives, and a Medicaid scheme for the rural and urban poor. There will be emphasis on strengthening the basic public health system; distributing essential drugs through a national organisation; creating health records for all citizens; strengthening the community medicine network of health-gatekeepers and nurses, and correcting “the tendency for commercialisation¶ in public hospitals. These guidelines, drawn up after wide public consultation, have been outlined by the Chinese Health Minister, Zhu Chen, in a recent edition of The Lancet. Clearly, nothing like this has been undertaken by any large country in recent decades.
India, with its 1.17 billion people, must urgently catch up — by formulating its own time-bound agenda for health reform. Although corporate-led for-profit health care services have expanded in recent years, health financing has not. Health insurance schemes are expensive, catering to a minority, and, in their present form, offer limited benefit. Not surprisingly, over 80 per cent of all health expenditure is being met out-of-pocket. This has an extreme and impoverishing impact on millions of families who have to care for those with chronic conditions such as diabetes, cancer, cardiovascular problems, and kidney disease, not to speak of debilitating infectious diseases. An immediate stepping up of public expenditure on health to at least three per cent of GDP has become an imperative. By itself this will not transform health care across the land. But without such investment, there is no question of India responding well to the challenge of lowering the disease burden in town and country, promoting public health, developing good public hospitals, and protecting the most vulnerable groups.
