History of healthcare models around the world and where India is headed in terms of universal coverage, health news, ET HealthWorld

by Dr Suman Katragadda

Healthcare in India has come a long way in terms of progress, however, it is no secret that the country still faces an uphill battle to provide better and more affordable healthcare to the whole of its 1.3 billion citizens. Amid this difficult landscape, however, there are also signs of hope and opportunity. One of the most promising developments is the increase in conversations around universal health care coverage. It is about ensuring that everyone has access to quality care, regardless of their socio-economic status. To achieve this, there needs to be a coordinated effort and mindset shift among healthcare providers, payers, policy makers and patients themselves to ensure we are moving towards a better model of healthcare. which can benefit everyone.

Traditionally, there have been 4 broad-based healthcare models that have been deployed globally.

The Beveridge Model
Named after British economist William Beveridge, who first proposed it in 1942, this type of health care system is one where health care is provided and funded by the government through user fees. taxes. Countries where this model is in place include the UK, Spain, most Scandinavian countries and New Zealand. With this model, there are no out-of-pocket costs to patients since taxes fully fund the program. And there is no charge for government-provided medical care for all taxpayer citizens.

The Bismarck model
This model has European heritage and was named after Prussian Chancellor Otto von Bismarck. It is based on an insurance system and the entire health care structure is jointly funded by employers and employees through payroll deductions. In this system, health insurance schemes must cover everyone. The countries that use this healthcare model are Germany, France, Belgium, the Netherlands, Japan and Switzerland.

National health insurance model
This health care model is designed to provide comprehensive coverage to all citizens of a country. This system has elements of the Beveridge and Bismarck models of health care; this involves hospitals and private sector providers, however, payment comes from a government-run insurance program in which every citizen contributes and contributes. It’s a strictly not-for-profit model as opposed to the American system. This model of health care is found mainly in Canada and also in some newly industrialized countries such as Taiwan and South Korea.

Ready-to-use model
A popular model in several developing countries, including India, this model implies that individuals are responsible for paying all medical costs out of their own pocket. This can be done directly or through private insurance or through government sponsored programs. The direct payment model has a number of disadvantages. First of all, as we already know, it can be very expensive, especially for people with chronic conditions. And above all, it acts as a major obstacle for people from socio-economically disadvantaged backgrounds. This leads to unequal access to medical care because a person’s ability to access medical care depends solely on their financial capacity. Besides India, this pattern is found in China and countries in Africa and South America, as well as among uninsured or underinsured populations in the United States.

India’s attempt to improve access to healthcare and the challenges to it
In the recent past, India has attempted to improve access to healthcare for a large number of its citizens who remain below the poverty line or have difficulty accessing healthcare due to their socio-economic status. disadvantaged. The Ayushman Bharat National Health Protection Mission is an example; the program aims to provide affordable health care to nearly 40% of the poorest and most vulnerable populations in India. As admirable as this program is, unfortunately, due to India’s massive population and other challenges such as vast geography, the Ayushman Bharat program alone will not be enough to put the country on the right track for health care. universal similar to its Western counterparts.

When it comes to government-mandated programs like Ayushman Bharat that aim to provide subsidized or near-free health services to vulnerable people, one of the biggest challenges for hospitals is affordability. This is especially true for metropolitan and large city hospitals that are expensive to run and have large operating budgets. For these hospitals, generating profits is imperative to continue providing good quality health care. Simply put, when hospitals, both urban and rural, are required to comply with programs such as Ayushman Bharat, they may be pressured into compromising on quality of care in order to compensate for losses while providing health services. subsidized.

Such a scenario can lead to patients receiving poor quality care, which can lead to possibly higher rehospitalization rates and an overall loss scenario for hospitals, insurance companies, and patients. This leaves the whole system in turmoil because on the one hand, to become a fair country, it is imperative that every citizen has access to health care despite their ability to pay, but on the other hand, the uncomfortable truth is that hospitals need to generate revenue. Thus, there must be new and better ways to improve the healthcare scenario in India.

One of the best ways to ensure that hospitals are not forced to reduce the quality of care and make decisions such as using substandard medical supplies in order to make up for losses is to strengthen the care infrastructure. in Tier 2 and Tier 3 cities. Currently, all healthcare infrastructure is concentrated in major cities and urban areas. But this approach is flawed because semi-urban and rural areas that have small hospitals and nursing homes, single-bed doctor’s surgeries and dispensaries, require low operating costs and have the capacity to provide care to tariffs imposed by regimes such as Ayushman Bharat. However, this is only possible if the government invests in improving these facilities and supports the construction of quality medical infrastructure. The path of public-private partnership can be explored here as it is almost impossible for the government to cover the vast population and geographical area of ​​the country.

The bottom line is that to improve the country’s health system, in conjunction with the distribution of free or subsidized care, the primary health care ecosystem must be strengthened. Fully fledged primary health care centers with referral systems in place and strong GP clinics in rural areas are key to moving India’s health care system from the unorganized model to a structured system – a system in which quality health care is accessible and affordable for all citizens.

Dr. Suman Katragadda, Founder and CEO, Heaps.ai

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