Universal health insurance would be a massive wealth transfer from taxpayers to the private sector

Nobody reading this article is unaware of the tremendous disparities in Indian healthcare. Medical tourists from across the world get treated at internationally accredited private hospitals while most Indians wait for weeks to get treated, if at all, at overburdened district hospitals. The government has decided to provide universal healthcare through a combination of new policies, capital expenditure, regulatory coercion and advertising campaigns. In my opinion, this path takes us far away from truly universal healthcare and would saddle the nation with a first-world bureaucracy layered atop third-world infrastructure.

A few months ago, an international development agency sought my advice on a consulting project with the highway ministry. Their plan was to sell the NHAI on building a network of Level-3 Trauma centres that would attend to road accident victims. Great idea, I said, but wouldn’t you have fewer accident victims if you spent that money on guard rails and better lighting? This country needs more hospitals, the benevolent imperialists interjected. We don’t have enough doctors, I snapped back. They haven’t gotten back to me since.

One of the more ballyhooed measures towards health-for-all was the decision to cap implant prices. Stents used to subsidise the cost of procedures; when implant margins reduced, the procedure cost increased. It did nothing to reduce the overall cost of angioplasties and succeeded in driving away the latest generation of cardiac implants from the Indian market. If the government was keen on reducing angioplasty prices, they should have focussed on the real cost drivers – doctor salaries and imported cathlabs. There’s an artificial shortage in both that can be solved by increasing supply.

The announced-but-yet-to-be-rolled-out universal health insurance could transform healthcare in this country. The problem is that since 70 per cent of beds are in private hospitals, UHI would be a massive wealth transfer from taxpayers to the private sector. Once you walk past the corpses of health activists who’ll choke on their umbrage, you’ll have to contend with the fact that there isn’t enough taxpayer money to pay for everyone’s healthcare. A more appropriate programme would mimic Singapore’s mandatory Health Savings Account – the government contributes an amount that provides basic care, employers add more as part of the salary package, and consumers top it up when necessary. Insurance cover depends on contribution, and government hospitals, teaching hospitals, and private hospitals are all paid from the same account.

Another major government initiative was building AIIMS-like hospitals in every state. These clones cost around Rs 1600 crores each (around twice the cost of a JCI-grade private hospital), and have struggled to get off the ground. Tertiary hospitals are the last, the most expensive link in the healthcare delivery chain. Focussing on nutrition, sanitation, and education will lead to better overall health outcomes than solving every healthcare issue with more infrastructure. With limited funds to spare, it behoves a responsible administration to choose interventions that offer more bang for the proverbial buck.