‘Modicare does not address India’s health inequities’, find study

Prime Minister Narendra Modi's ambitious National Health Protection Scheme (NHPS), or Modicare, fails to address the enormous inequities in India's health sector, says Purendra Prasad, who, along with Amar Jesani, has edited "Equity and Access: Health Care Studies In India".

"The National Health Policy 2017 and the Union Budget 2018-19's announcement of the world's largest health insurance programme clearly indicate the direction in which the Modi government is driving health policy," said Prasad, whose book is a part of Oxford India's Studies in Contemporary Society series and is a compilation of contributions by experts and noted personalities from the healthcare segment.

"The NDA (National Democratic Alliance) government in the last four years changed the nomenclature of health programmes but visualised health care and public provisioning in terms of health insurance markets and public private partnerships.

"Unless healthcare is detached from the marketplace and developed as a public good, there is no possibility of addressing the question of health inequities in India. This is the direction in which countries are moving the world over, and there is no reason why India should be any different," Prasad, the Head of Department of Sociology at the University of Hyderabad, told IANS in an email interview.

Most of the countries including the UK and Canada, he said, do not leave healthcare to the whims of the market but ensure that it remains a public good and the state's responsibility.

"While the public policy under the NDA regime persistently denies any attempt at privatization of the health sector, every policy initiative is directed towards strengthening the private sector and weakening the public sector."

The ambitious health insurance scheme which was announced by Finance Minister Arun Jaitley in his budget speech is said to benefit an estimated 500 million people.

Jaitley said the world's largest funded healthcare programme has been allocated Rs 2,000 crore and each beneficiary family shall have an insurance coverage of up to Rs 5 lakh per year.

The book "Equity and Access: Health Care Studies in India" contends that there is "enormous inequities in the health sector" across caste, gender and class.

Asked to share his observations on the reasons behind these inequities, Prasad, who has published extensively on questions of health inequities and caste-class dynamics, said the role of the state has significantly changed and has allowed private capital in the healthcare industry.

"Several studies point out that India's recent history of healthcare is not simple state policy intervention but one of state policy governing private enterprise. Significantly, the guiding philosophy of state action is grounded in the commitment to make 'public-private partnership' the cornerstone of health policy, which, no matter how it is couched, has meant that public investments are increasingly geared to securing private rather than social interests.

"In so doing, the state ends up often being only a market activist in relation to capital accumulation. Second, the market has had increasing influence in the development of healthcare, such that it is no longer protected from its vagaries in any sector - pharmaceutical, medical device, medical education and provisioning aspects. The most evident result of this trend has been the corporatization of healthcare which is rooted in capital's logic of accumulation and profit maximization."

So what is the way forward?

"A running thread throughout the tapestry of healthcare system is the emphatic assertion that health equity issues cannot be addressed satisfactorily without some form of a universal health care structure and system," he said.

The last section in the book critically scrutinises the recent policy intent of India to achieve universal health coverage by 2022 and the need to enact the right to healthcare legislation announced in its National Health Policy 2017.

It opens a window to explore and explain the possibilities of achieving universal access at both the conceptual and pragmatic levels.

The major focus of the book lies in unravelling the complex narrative of why inequities in the health sector are growing and access to basic healthcare is worsening, and the underlying forces that contribute to this situation.