8. CONCLUSION 8.1 Reform Themes The agenda for reforms presented in this report aims at focussing on free Government-funded health care for the most needy. It induces those who can pay for health care to do so, but through new financing mechanisms designed to ease the burden of obtaining health care when it is most needed. It suggests an overhaul of the structure and provision of health care, taking cues from initiatives in other countries. At the heart of the new model is decentralisation, contracting for health care services and introducing healthy competition by more effectively involving the private sector - voluntary, not-for-profit charitable and for-profit health care providers. A shift of funding and activity away from curative care to a strong emphasis on promotive and preventive health, particularly aimed at emerging lifestyle diseases, is imperative. 8.2 Health Care Finance A reform of the health sector on the lines recommended will enable different segments of the population to contribute to the cost of health care according to their ability to pay. Government funding will be primarily used for the poorest and indigent groups and for priority public health services such as communicable disease control, immunisation and family welfare. Other groups, except for the poor and indigent, will be expected to pay some or all of the costs of health care. A range of financing mechanisms would have been introduced to ensure that the medium and higher quintile socio-economic pay for health care and government’s resources are directed to support the poor. These mechanisms will include social insurance which will be encouraged for all groups other than the poor and indigent, private health insurance, community-supported health financing schemes for the rural population and user charges. 8.3 Health Care Delivery The reforms suggested will enable Government financed health care delivery system to focus largely on providing essential health services for poorer and indigent groups free of charge and providing health prevention and promotion services that target priority communicable and non-communicable diseases. It would induce middle and higher income groups to obtain health care from either public or private providers on payment basis. New forms of organising health care services – including Health Maintenance Organisations and ambulatory care - will most likely emerge as increased competition develops among providers. 8.4 Government Role The agenda for reforms would enable many of the current roles and responsibilities of state Governments in health care to be decentralised. The central government would play a more active and effective role in regulating the entire industry (e.g. accreditation of health care facilities) and to reduce disparities among the states. Government funded health care providers would have more autonomy, giving them greater capacity to innovate, generate, retain, utilise and manage funds. Consumers would be empowered with better knowledge and understanding of their health needs. 8.5 Quality The recommendations would enable improved quality of care, including more effective and appropriate treatment, more patient-focussed care and better monitoring and benchmarking of providers. 8.6 Epilogue The challenge of the future is daunting. Rapidly escalating health care demand fuelled by a dual burden of disease and population growth and the rising expectations of a wealthier and better-informed society will place an untenable strain on the nation’s health care system. The current approach will not suffice. The costs are huge, but there are enormous payoffs in long-term investment in health care. Such investments can not only raise quality of life for all citizens but also make the health care industry in India a great force for economic growth. Health care reform is urgent and strong government commitment at the centre and states is the key to its success.
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