Articles by Ravi Duggal

Healthcare for India’s Poor: The Health Insurance Way by Sonalini Khetrapal, New Delhi, Gurugram: Academic Foundation, 2019; pp 192, `1,195.

The economic catastrophe precipitated by the COVID-19 pandemic and the response of the dismal public health system has actually led to the heightening of the public health crisis. If the migration of workers from cities is not stopped through appropriate economic support measures, the public health crises will worsen because most migrants are returning to states that have very poor healthcare systems with limited capacities to deal with such crises. This pandemic also offers a political opportunity for governments to focus on strengthening the primary healthcare and public health systems through bold experimentation and strategies.

Healthcare as a public good should be available free of charge at the point of service delivery. This was the case across India until a flurry of reforms from the early 1990s onwards notified user charges for various health services in public health facilities. Since then, public expenditure on healthcare has seen a decline from a high of 1.5% of gross domestic product in the mid-1980s to a low of 0.7% of GDP in the mid-1990s, recovering to 1.2% of GDP presently. However, out-of-pocket healthcare expenditure has risen dramatically with increased user charges in public health facilities, which leads to further inequities.

The NITI Aayog has effectively stalled the finalisation and tabling of the National Health Policy 2015 in Parliament. The document, including the Parliamentary Standing Committee on Health and Family Welfare's report, should be revived to put forth a concrete plan for transforming the healthcare system in India.

In a formal sense, the Government of India provides considerable transparency in the budget process, but in a substantive sense, public participation is very limited. The Fourteenth Finance Commission has the opportunity to recommend true budget transparency, accountability and participation.