India's Healthcare System Faces Crucial Crossroads: Report Calls for Public Sector Dominance
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A landmark report released on Wednesday has urged India to prioritize publicly provided healthcare, citing governance failures and fragmented delivery as major barriers to universal coverage. The Lancet Commission's report, based on a massive survey of 50,000 households across 29 states, outlines a roadmap to achieve universal health coverage by 2047. While India has made significant strides in vaccine and pharmaceutical manufacturing, its domestic health system is marred by uneven quality and inefficiencies, leaving millions vulnerable. The report proposes six structural reforms to overcome these challenges, including empowering citizens, decentralizing authority, and leveraging technology to coordinate care. It also calls for the public sector to take a more active role in purchasing services and embedding a 'learning health system' culture to improve accountability. The commission believes that engaging the private sector as a partner, rather than sidelining it, is essential for achieving universal coverage. This push for public sector dominance challenges the status quo in India, where nearly half of households rely on private providers despite higher costs. Co-chair Vikram Patel emphasized that only the public sector has the mandate and infrastructure to achieve health equity. However, the report acknowledges the private sector's significant footprint and recommends aligning it with national goals through a balanced mix of incentives and regulation. As India strives for 'Viksit Bharat' status by 2047, the report notes that the government's Ayushman Bharat insurance scheme, which covers 600 million people, is limited to hospitalization. This leaves families to bear the crushing burden of outpatient costs and medicines. Co-lead author Anuska Kalita emphasized that India has a historic opportunity to transform its health system and make it work for every citizen.
