Action Points

To ensure Health Care- for All, the Government must:

1. Mandate Universal Health Insurance to provide basic medical coverage to all through duly regulated Private and Public Insurance Companies. The recent ‘Ayushman Bharat Scheme is a step in the right direction, but by not having a first cost co-pay element it is not very realistic.
2. Fix premiums on a community rating basis with standard riders for professions, age and geographical locations etc. only. No exclusions due to previous / chronic illness etc.
3. Allow for the option of additional premiums to obtain additional levels of coverage or care and for additional levels of ambience and comfort.
4. Call for meeting first costs by the Patient at levels to be fixed so as to avoid infructuous claims and needless calls on scarce medical resources. Subsidize the really needy in a pre-determined and transparent manner. (Patient Welfare Committees at all hospitals)
5. Allow Private Insurance Companies to compete, again in a transparent manner prescribed by the designated Regulatory Authority, and to offer plans, but do not allow them to ‘cherry pick’ the Customers. No ‘Risk selection’, No ‘Pre screening’, No ‘Denial management’ or excuses to deny Insurance.
6. Exempt Health premiums from Income Tax subject to set percentage of taxable income. Perhaps allow the premiums to be collected as additional contributions to the Provident Fund or Pension Fund and Paid Out from such fund as in Singapore. If subject to GST, the rate could be one percent or at the most at five percent.
7. Appoint an Agency / Agencies, as deemed practical, to regularly bargain and fix prices for standard tests and procedures and for procurement of Standard and Generic drugs and medical equipment, prosthetics and implants in a regulated and transparent manner.
8. Ensure standards are set for every class of diagnostic centre, clinic or hospital, both for infrastructure and staff and that they are regularly rated and inspected and their staff made to undergo regular skill upgradation courses. This will reduce medical treatment errors and also, hospital caused diseases. This will also, allow the patients to meaningfully select the type of hospital care they desire.
9. Specify measures for preventive care and methods to ensure their implementation through Social and Financial incentive programs and even from School levels.
10. Proper validation of Traditional Medicines and recognition of the qualification of its practioners must be ensured.
11. Widely advertise to inform the Public to participate in such Universal Health Care Insurance Program. Allow all other Health Programs to be incorporated into this.

As all are covered for all basic health problems and predetermined procedures in the basic coverage package, administrative costs are kept low and drug prices are also, kept low because of regulated pricing policy and procurement at competitive prices, through a Centralized Agency tasked to bargain and fix the prices for standard Tests, procedures and standard / generic drugs, the costs of such a Universal Health Care Insurance Program would be very low. Experimental drugs, advanced treatments and procedures and better ‘Room and Board’ and attendance of more qualified doctors / consultants may need riders or additional sharing of costs / payments by the patients.

Robin Cook, Physician and Author, highlights- another important factor in keeping Health Care costs down. That is by keeping malpractice cost / claims down to a reasonable level. A peer review panel of independent Physicians, down to district levels, can be tasked to review any such claims. This will avoid unnecessary tests, consultations and procedures ordered by the physicians more out of fear than necessity. Such peer – review committees will also, ensure effective deterrence to medical negligence. A kind of ‘No – fault’ insurance, or even something similar to worker’s compensation for doctors, or even methods of arbitration / mediation can also, be considered.

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