A. P. LEGAL SERVICES PVT. LTD.
Legal Empowerment through Professional Excellence

CHAPTER-1

INTRODUCTION

“Should medicine ever fulfil its great ends, it must enter into the larger political and social life of our time; it must indicate the barriers which obstruct the normal completion of the life cycle and remove them. Should it ever come to pass, Medicine, whatever it may then be, will become the common good of all."

                                                                                                       (Rudolf Virchow, c.1850)

Right to life includes ‘Right to health’. Right to health cannot be confined to particular bureaucrats, Government, health experts or doctors but it should be accessed by every human being and specially the most marginalized must be assured of basic health care service and can demand access to this right without any fear. Looking at the issue of health under the equity regime, it is clear that the massive burden of morbidity and mortality suffered by the deprived majority is not just an unfortunate accident, but a denial of a healthy life because of structural injustice within the health sector. To achieve a decent standard of healthy life, it requires a range of far reaching social, economic, environmental and health system changes. To change the whole system we have to transform everything into shape within and beyond the health care sector which would ensure an adequate standard of health for all.

It is now established and recognized that right to health is a basic human rights and along with the basic human care is needed to a population for sustainable and equitable economic growth. The ‘Economic Growth above all’ by Dr. Amartya Sen says,

     'Among the different forms of intervention that can contribute to the provision of social security, the role of health care deserves forceful emphasis. A well developed system of public health is an essential contribution to the fulfilment of social security objectives. We have every reason to pay full attention to the importance of human capabilities also as instruments for economic and social performance. Basic education, good health and other human attainments are not only directly valuable. These capabilities can also help in generating economic success of a more standard kind.”[1]

The right to basic health care is recognised internationally as a human right and India is a signatory to the International Covenant on Economic, Social and Cultural Rights which states in its Article 12. The States Parties to the present Covenant recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. There are various steps that can be taken which include those necessary for the creation of conditions which would assure to all medical service and medical attention in the event of sickness. There are other similar International Conventions, wherein the Government of India has committed itself to providing various services and conditions related to the right to health, e.g. the Alma Ata declaration of ‘Health for all by 2000’. The National Human Rights Commission has also concerned itself with the issue of 'Public health and human rights' with one of the areas of discussion being 'Access to health care'. The need of the hour is to ensure the action in realistic manner, time-bound and accountable framework.

 The term ‘deficiency’ in medical services should extend beyond the doctrinal definition for the term given under the consumer protection act 1986, for the purpose of promoting human rights. The foundation of this term in fact stems from the concern expressed by the International Organisation for Consumer Unions[2] (IOCU) and the United Nations Guidelines on Consumer Protection[3]. If deficiency in medical services is examined in the light of the principles projected by these bodies, the following circumstances can be identified as leading to deficiency in medical services.

• Denial to access health services which include access to basic medical services.
• Advanced medical treatment which may be life saving procedures, cosmetic procedures, or procedures for satisfying desirable human needs.

Failure to provide safety of products used in health care services, experimental medicines and clinical trials on human beings and abuse of diagnostics and curative procedures can also lead to human right violation. India urgently needs to spend more on healthcare and save its poor population from poverty and hunger or face the risk of slower economic growth and sustainable development which is very much important to meet the millennium development goals. It is worth saying that a sick and vulnerable population which cannot act at par with healthy population, will not contribute much to the economic development of our country. “It is a hard fact to digest that the Government spends only 1% of its gross domestic product on healthcare facilities, forcing millions to struggle to get and access healthcare services in India. Indian authorities themselves admit of corruptions and inefficiency in the government system, especially in villages where health centres do not have medicines or doctors. After calculations it is said that to meet the success of millennium development goals by 2015, India needs to spend 3% of its GDP on health sector. The crucial fact is that India’s maternal mortality rate (MMR) stands at 450 per 100,000 live births against 540 in the 1998-99 period - and way behind the MDGs which call for a reduction to 109 by 2015. To improve this poor condition, India needs to increase public expenditure and ensure better healthcare facilities.”[4]

CHAPTER-2

INDIAN HEALTH SECTOR: FACTS AND FINDINGS

After starting of the privatization era, the private health sector in India has been increased tremendously. But health care services are provided by both public and private sector. More numbers of private hospitals and taking huge amount of salary is causing for shortage of medical practitioners in the public sector. The Government though tries to increase number of public hospitals but forget to support them financially. The result is that the number of hospitals increase and infrastructures remain the same for which there is shortage of beds and facilities. The situation is perpetuated by low Government spending on health, despite the fact that the majority of population depend on public sector due to their low income. The private hospitals charge so much money that sometimes a person is bound to borrow money or to sale his assests.

“The main problems affecting the success of primary health centers are the predominance of clinical and curative concerns over the intended emphasis on preventive work and the reluctance of staff to work in rural areas. In addition, the integration of health services with family planning programs often causes the local population to perceive the primary health centers as hostile to their traditional preference for large families. Therefore, primary health centers often play an adversarial role in local efforts to implement national health policies.”[5]

“Indigenous or traditional medical practitioners continue to practice throughout the country. The two main forms of traditional medicine practiced are the ayurvedic  system, which deals with causes, symptoms, diagnoses, and treatment based on all aspects of well-being (mental, physical, and spiritual), and the unani (so-called Galenic medicine) herbal medical practice. A vaidya is a practitioner of the ayurvedic tradition, and a hakim (Arabic for a Muslim physician) is a practitioner of the unani tradition. These professions are frequently hereditary. A variety of institutions offer training in indigenous medical practice. Only in the late 1970s did official health policy refer to any form of integration between Western-oriented medical personnel and indigenous medical practitioners. In the early 1990s, there were ninety-eight ayurvedic colleges and seventeen unani colleges operating in both the governmental and nongovernmental sectors.[6]

In India the most important primary medical care is available in rural areas as well as in towns, which are called as ‘primary health care’. But the whole public healthcare delivery system is quite systematic and the flow chart goes like this.

                                     Public Healthcare Delivery system

Public Healthcare System in India is suffering from deadly diseases which are need to cured from the primary stage or it can lead to death of people due to improper healthcare service in Primary Centres. In India till date 132,000 Sub Centres, 22,000 Primary Healthcare Centres, 7000 Community Health Centres or the District Hospitals are available. Among these centres many of them are bad in condition, buildings are in a dilapidated condition and in most of them, doctors are not available. Therefore, one can find only few Centres where people can access healthcare services. Another problem is regarding transportation facilities to a Centre, which is very poor in most of the Indian villages, as there is no proper road to reach to the health centres. Most of the time due to lack of electricity connection Patients have to stay in the Centre in dark. If in a Centre, one cannot find any of these problems, then there will be problem regarding the lack of drugs and essentials supplies to the Centre or the non-functional equipment.

Poor Health Insurance policy

There are various challenges to Indian health financing. Such as;

1-Increase in Health care costs 2- High financial burden on the poor 3-Need for long term and nursing care for senior citizens 4-Increasing burden on new diseases and health risks 5-Due to underfunding, preventive and primary care and public health functions are yet to meet their objectives.

The new economic policy and liberalization process followed by the Government of India since 1991 paved the way for privatization of insurance sector in the country. Health insurance, which remained highly underdeveloped and a less significant segment of the product portfolios of the nationalized insurance companies in India, is now poised for a fundamental change in its approach and management. The Insurance Regulatory and Development Authority (IRDA) Bill, which has been passed in the Indian Parliament, is important beginning of changes having significant implications for the health sector. The health insurance in India can be defined broadly by including all financing arrangements where consumers can avoid or reduce their expenditures at time of use of services. In India only about 2 percent of total health expenditure is funded by public or social health insurance while 18 percent is funded by government budget. In many other low and middle income countries contribution of social health insurance is much higher.

CHAPTER-3

CHALLENGES IN HEALTH SERVICE: HUMAN RIGHTS LAW APPROACH

3.1 Rights of Patients

“Patients rights emanate from human rights, constitutional rights, civil rights, and consumer rights, codes of ethics of medical and nursing profession. The Indian Constitution bestows certain rights on the citizens.  One of them is Right to life.  Right to a healthy life is an integral part of the Right to life. WHO’s definition of health includes physical, mental, social, environmental and spiritual aspects of health.  Any threat to health care must be considered as denial of the Right to Life.  Basic optimal health care is the right of every Indian citizen and it is the responsibility of the state to provide it.  The Government in the country has legislated certain laws to protect the citizens.  Some of these are, The Drugs and Cosmetics Act, The Medical Council Act and The Consumer Protection Act.  The codes of ethics of medical and nursing councils define the duties of the doctors and nurses towards the patients.  Thus these duties form the basis of patient’s rights.”[7]

• Right to considerate and respectful care.
• Right to information on diagnosis, treatment and medicines.
• Right to obtain all the relevant information about the professionals involved in the patient care.
• Right to expect that all the communications and records pertaining to his/her case be treated as confidential
• Right to every consideration of his/her privacy concerning his/her medical care programme.
• Right to expect prompt treatment in an emergency
• Right to refuse to participate in human experimentation, research, project affecting his/her care or treatment.
• Right to get copies of medical records
• Right to know what hospital rules and regulations apply to him/her as a patient and the facilities obtainable to the patient.
• Right to get details of the bill.
• Right to seek second opinion about his/her disease, treatment, etc.

Access to Healthcare is limited by

• Dysfunctional Physical Infrastructure
• Lack of adequate human capital
• Poor healthcare financing

Poor Healthcare Financing

      National sample Survey revealed that,

• An increase in the absolute number of persons unable to seek healthcare due to financial reasons 
• About 40% of the hospitalised having had to borrow money or sell assets during the decade 1986–96
• Around 24% of all people hospitalised in India in a single year fall below the poverty line due to hospitalisation.

An analysis of financing of hospitalisation shows that a large proportion of people, especially those in the bottom four-income quintiles borrow money or sell assets to pay for hospitalisation.[8]

Many reasons exist for poor health resources availability in villages and slums of India. Significant reasons are governmentalization of medical resources and mismanagement of public health provisioning.  Public health education can remain with the government. More emphasis should be on privatisation of public health than scarcity of manpower. Manpower scarcity will automatically be improved as the market takes over. India needs to repeat its privatisation saga with respect to medical care and health infrastructure provisioning and maintenance but with greater degree of compassion, and can ensure some safeguards before allowing full fledged competition.

Communicable diseases not only continue to be the single largest cause of mortality but prevalence of many diseases like tuberculosis and malaria has increased and diseases like AIDS, leptospirosis, dengue etc. have got added to the list. Public investment in the health sector since the Structural Adjustment Program (SAP) has declined and this is reflected in drastically reduced capital expenditures and no further expansion in the public health infrastructure. In addition, revenue expenditures on health have declined both as a proportion to the GDP as well as a percentage of total public spending, and within this reduced expenditure allocation inefficiencies have increased especially after the 5th Pay Commission. The above has further reduced the credibility and acceptability of the public health system and one sees declining utilisation rates of public health facilities. On the other hand the dominance of the private health sector is increasing but with absolutely no regulation and minimum standards being followed. The medical profession pays no heed to self regulation or ethics and has never looked at the possibility of an organised system of healthcare.

3.2 Indian Constitutional Guarantees

Article 21 includes ‘right to health’ under ‘right to life’. Article 47 of Indian Constitution says: “Duty of the State to raise the level of nutrition and the standard of living and to improve public health. The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health.”

“The duty to provide health facilities is a constitutional mandate. This positive duty includes the duty to provide reasonable facilities for medical care.”[9]  In Paramananda Katara v/s U.O.I. [10] the court made only a declaration that legal or procedural technicalities cannot stand in the way of a doctor providing emergency medical care to accident victims. The decision does not impose any positive obligation on doctors or private hospitals to provide medical services to even accident victims. The Paschim Banga verdict of the Supreme Court reiterates the position that right to medical services is part of the right to life and the State has a duty to provide it. In India prominent players in the health care scene are private hospitals. In the absence of any duty on the private sector health care providers, the declaration of the Apex Court may not yield any benefit to hapless victims of accidents. In the case of non-emergency situations also there is duty on the State to make available health care services at reasonable costs. But the Indian scenario is painful. Due to soaring prices of medicines and other facilities connected with medical treatments, the poor man has to depend entirely on State aided health services. But in spite of the ruling in Paschim Banga, the conditions of Govt hospitals still continue to be dismal. Many hospitals lack facilities and even essential medicines and the patients have to purchase these from open market.

Progress of medical science and technology helped humanity to overcome many conditions of ill health, which were previously considered to be incurable. Many of these procedures are highly expensive and cannot be afforded by common men. Some of these developments include life saving procedures like heart surgery and transplantation of human organs like kidney, liver and bone-marrow. Many of the civilized countries including India have gone for control over human organ transplantation. Very often administrative procedures are envisaged for monitoring the process. The Human Organs Transplantation Act 1994 applies only to a few  States and even in those States there is no machinery to ensure absence of abuse of discretion by the administrative agencies. The result is that many valuable lives, which could have been saved, are lost due to the carelessness and lack of interest by the authorities concerned.

3.3 Safety of products used in health care

An important aspect in the health service sector is the quality, safety and prices of products used in medical treatment. Substantial injury may arise as a result of marketing of hazardous product. In A.S.Mittal v/s U.O.I.[11] and Sunil Blood Bank[12] case, courts had imposed liability for sale of unsafe products. The human rights aspects relating to hazardous drugs was considered by the Apex court in Vincent Panikulangara v/s U.O.I.[13] and Common Cause v/s U.O.I.[14] it gave many directions for improving the drug policy and functioning of blood banks in India. It is doubted whether all these directions resulted in any substantial improvement in these sectors. Quality control at production stage and at the point of sale and use, contained in the Drugs and Cosmetics Act, 1945, is laudable, but lacks rigorous implementation. The result is repetition of tragedies year after year. Sale and supply of undesirable combination is the order of the day. The Hathi Committee recommendation for adoption of an ‘Essential Drug List’ and prohibition of sale of undesirable combinations still remains a distant dream. The Drug policy announced by the Government of India in 1994 also does not contain any positive step in this regard. The result is that thousands of drug formulations having dubious benefits, flood the market. Taking advantage of the inadequacy or even absence of control in production of herbal drugs, Indian market is flooded with herbal medicines. Most of these medicines possess no beneficial qualities.

3.4 Abuse of diagnostic and curative procedures

While the break-through in medical science helps to promote health of people, the abuse of those procedures can lead to disastrous consequences. The Pre-natal Diagnostic techniques are often used to determine the sex of the unborn child and indulge in female Feticide. Similarly the chances of organs like kidney. Regarding Pre-natal Diagnostic Techniques (Prevention of misuse) Act, 1994 and the Human Organ, Transplantation Act, 1994, they have limited applications. It is only enforced in four States and Union Territories.

These are the some of the areas where the human rights concerns of one person may conflict with similar concern of another person. Thus in termination of pregnancy and sterilization, the interest of male and female may conflict. The European Commission on Human Rights held that failure to consult the father before abortion of his wife, violated human rights of the father. But subsequently the Commission reversed its position and gave primacy to the health- physical and mental of the mother.

CHAPTER-4

REMEDIES TO THE PROBLEM

• Public-Private Partnership

The goal is to achieve optimal health for the people, which would allow them to lead socially and economically productive lives. The health care system envisaged would have a public-private mix, with the latter encouraged to take a greater share in health care services. The public-private partnership argues that these partnerships have broken down the traditional boundaries between the market and the State, leading to the emergence of multiple actors with multiples roles and newer institutional arrangements that have redefined their role and authority has serious consequences for comprehensiveness, governance and accountability of health services. To address emerging threats to health, new forms of actions are needed. There is a clean need to break through traditional boundaries within government sector, between governmental and non-governmental organization and between public and private sectors. Cooperation is essential and this requires the creation of new partnerships for health, on an equal footing, between the different sectors at all levels of governance in society. The term partnership in the public-private partnership is difficult to define. Some definitions are very much ambiguous to understand. However, partnership is often used to describe a range ofinter-organizational relationships and collaborations. Some of the useful definitions provided by different sources are worth saying here.

• “It means to bring together a set of actors for the common goal of improving thehealth of a population based on the mutually agreed roles and principles” [15]
• “a variety of co-operative arrangements between the government and private sector in delivering public goods or services provides a vehicle for coordinating with non-governmental actor to undertake integrated, comprehensive efforts to meet community needs to take advantage of the expertise of each partner, so that resources, risks and rewards can be allocated in a way that best meets clearly defined public needs” [16]
• “a partnership means that both parties have agreed to work together in implementing a program, and that each party has a clear role and say in how that implementation happens” [17]
• “a form of agreement that entails reciprocal obligations and mutual accountability, voluntary or contractual relationships, the sharing of investment and reputational

risks, and joint responsibility for design and execution” [18]

Therefore it requires collective sense of equality, cooperation and co-ordination among partners,collaborative effort and reciprocal relationship between two or more parties with clear terms and conditions, clearly defined structures and performance indicators for delivery of a health services in a stipulated time period.

The health system has common objective of equity, quality, efficiency and accessibility. Generally the motive of Government is to provide health services to all at minimum cost and develops policies, programmes to provide equity access to all at minimum cost. So from public sector view there are merits and demerits in collaborating with private sector. The non-profit organization aims at educating poor and providing proper health services with better transparency. But they constitute only one percentage of health care service in India. Therefore people cannot access whenever they want. Their service depends on external funds, and donations which is again a demerit in providing service. So now the collaboration of these two sectors can provide a complete profile of health care services, where there will be fund from public sector and dedicated staffs, services, quality of health care and accessibility will be from non-profit sector. Partnership by public can be made with informal, non-profit or a profit organization i.e. a private sector. But in every sector there are some pros and cons which are worth mentioning here.

Sector                                                  pros                                         cons

                      Informal                       accessible client oriented                   low cost, poor quality care, poor   

                                                                                                Educated staffs                                  

Non-profit                  high quality, targeted to poor             Ad-hoc interventions, variable       

                                                                                               qualities, clustered in cities

Profit                          high quality technology,

                                   better services and care                       very costly

A successful partnership can be achieved by following various characteristics, such as:

• A clear understanding of partners about mutual benefits.
• A clear understanding of partners about their responsibilities and obligations.
• Strong community support
• Stability of the political and legal climate.
• A regulatory framework that is followed and enforced
• Appropriate organizational and management systems for partnership
• Strong management information  system.
• Clarity on incentives and penalty provisions.

4.2 Developing and strengthening specific health programmes.

Health and wellness are the primary concern for the State. Over the years, the government has introduced various health programmes and policies to better the standard of life of its citizens. 

• Central Government Health Schemes
• National Aids Control Program
• National Leprosy Eradication Program
• Vector Borne Disease Control Program
• National T.B. Control Program
• National Programme for Control of Blindness
• National cancer control Programme
• Mental Health Programme
• Rastriya Arogya Nidhi
• Prevention of Food Adulteration Programme

• Strengthening international partnerships for health.

The International Health partnership is a coalition of International Health agencies, Governments and donors to improve the health facilities in the developing countries to reach the health related Millennium Development Goals. Mutual responsibilities and accountability can be seen to develop and implement various national health plans. The developed nation partners will guide in a better way to help the developing nations to implement comprehensive national health plans. They can also provide aid which will develop health system. The partner countries will invest further their own health systems, address policy constraints to progress, strengthen planning and accountability mechanism to make them more inclusive and transparent. Civil society and other stakeholders will play an important role in the design, implementation and review of the International Health Partnership at global and country levels and in holding all parties to account.

The implementation process will be mainly country-led and outcome driven which will build on existing structures and mechanisms in countries. A high level work plan has to be prepared by the WHO and the World Bank in consultation with the partners. The work plan consists of four elements.

1. Enabling countries to identify, plan and address health system constraints to improve health outcomes in a sustainable and effective manner.
2. Generating and disseminating knowledge, guidance and tools in specific areas.
3. Enhancing coordination and efficiency.
4. Accountability and monitoring performance.

Global health partnership

Global Health Partnerships are a moving target in a changing environment, and the evidence to assess them is sometimes limited. Most current and planned interventions funded by GHPs are potentially high and cost effective. Neglected diseases are mostly addressed by GHP. It can be seen that GHPs are fit well with national priorities and programmes, though there may be issues about the priority given to polio and HIV.  

“More broadly, health system strengthening is a critical issue in its own right. Whatever the role of GHPs, there is clear need for donors and governments to invest more in health system strengthening if the healths MDGs are to be achieved. Different ways to make a more explicit connection between health systems support and GHP funding and access programmes are being explored. These include donors ‘top slicing’ their contribution to the financing GHPs.”[19] There may simultaneously be scope to rationalise some GHPs with low or unhelpful impact, but this would require a more systematic approach to monitoring and evaluation of GHPs. Several GHPs with time-limited elimination and eradication objectives will reach natural ends over the next few years. There is a specific need for GHPs to tighten the focus on securing proper and gender related objectives. GHP allocations are more focused on low income countries than recent donor commitments, and GHP allocations by disease are largely at least as pro poor as past allocations. GHPs can play a role in advocating and stimulating appropriate  policies and approaches, and special efforts need to be focused on the most impoverished, vulnerable and underserved populations, including women.

• Medical tourism as a major external driver for growth of the Indian healthcare sector.

“Medical tourism in India has emerged as the fastest growing segment of tourism industry despite the global economic downturn. High cost of treatments in the developed countries, particularly the USA and UK, has been forcing patients from such regions to look for alternative and cost-effective destinations to get their treatments done. The Indian medical tourism industry is presently at a nascent stage, but has an enormous potential for future growth and development.”[20]

Americans and Europeans are choosing to have surgery in India. This exciting new way of receiving medical treatment involves travelling to an advanced facility, having your treatment at a much lower cost and using the savings to opt for and enjoy a holiday during your recovery in an exotic location, which can recover a patient from a serious disease without any mental tension. Medical tourism is also for the people who either do not have medical insurance, NHS, etc or these are not enough to cover the treatment they need. Another  category of the people opting for medical treatment in India are those who need to take a medical treatment and also wish to take that holiday, so they combine their treatment and holiday together and still save big.

• The procedures in country like India are usually far less expensive. In certain cases, as less as 15% of the cost for the same treatment abroad.
• The medical professionals in these facilities are some of the most well-trained and experienced surgeons in their fields.
• The standard of hospitality at hospitals in India and certain other middle- Eastern Countries are far higher than in America or Europe.
• All doctors and medical staffs speak fluent English, as does most of the population.
• Many pharmaceuticals companies meet the U.S. Food and Drug Administration requirements and numerous Indian hospitals provide treatment and health care services that are simply available only here.  Many hospitals have the ICJ certificates which enable them to meet the most stringent norms.

Key benefits of medical tourism in India

• It provides world class treatment and fraction of comparative cost in western countries.
• Patients from 55 countries are treated in India only.
• The medical technology, equipments, facilities and infrastructure in India at par with International Standards.
• The Indian doctors are recognized as among the best at International levels.
• Indian is rated among the top 5 favourite tourism destination worldwide.

• Tele medicines

Since the early 1980s, information and communication technology has increasing also been used for tele-medicine, that is the provision of medical services using technology that bridges the gap between different geographical regions.

Tele-medicine can be more efficient than the other traditional method for treatment. The technology provides people comfort and convenience with little expenditure. The “long distance therapy” can often lead to wastage of time and money. Therefore this method is quite comfortable.

“Some of the bottlenecks with respect to the growth of Telemedicine in India are :

1. Lack of health infrastructure and services.

2. Shortage of computer savvy healthcare personnel.

3. Out flow of doctors:  There are about 60,000 and 35,000 Indian doctors in United States of America and United Kingdom respectively.

4. Lack of training facilities with regard to the application of information and communication technology in medicine.

5. Virtually no exposure to the applications of ICT in curriculum of medical colleges.”

6. Inadequate communication services to facilitate telemedicine in most of the cities but the situation is rapidly improving.”[21]

4.6 Medical Call Centre : Medical Care Anytime Anywhere

In India there is a gap in information related to reproductive, sexual health especially among the adolescents, about to be married and newly married couples. People are very much shy about visiting to medicals and to seek advice from doctors in the health matters like safe abortion, contraception, Sexually transmitted diseases and reproductive tract infections. There are people who do not want to consult doctors as they cannot bear the expenses. The call centre service caters mainly to this section of the population to provide them reliable and confidential information.

This service renders qualified doctors for the matter of consultation. The Call Centre primarily seeks to provide this service to the small towns and in due course villages in the State of Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh, Rajasthan, Uttar Pradesh and Haryana. This is largely because due to various socio- cultural factors people in all age groups, particularly women and young people do not have easy access to authentic information on these issues. This service is available to all the people who are not even from the States as mentioned above.

4.7 A better Health Insurance policy

India has limited experience of health insurance. After economic liberalization the Govt has liberalized the insurance industry, which is going to develop rapidly in future. Now the challenge is to see that it benefits the poor and the weak in terms of better coverage and health services at lower costs without the negative aspects of cost increase and over use of procedures and technology in provision of health care. From other aspects and experiences, it is seen that if insurance will be left to the private sector only, then it will only cover those which have substantial ability to pay leaving out the poor and making them more vulnerable. ‘ Hence India should proactively make efforts to develop social health Insurance patterned after the German model where there is universal coverage, equal access to all and cost controlling measures such as prospective per capita payment to providers.’[22] India does not have large organized sector employment and the only option for such social health insurance is to develop it through co-operatives, associations and unions. The existing health insurance programmes such as ESIS and Mediclaim also need substantial reforms to make them more efficient and socially useful. Govt should catalyze and guide development of such social health insurance in India.

CHAPTER-5

CONCLUSION

The lack of right to health care is the main reason why health status of the Indian population is unsatisfactory. Health indicators across the board are close to the worst and within the country inequities across classes are very sever. India will have to address its healthcare access challenges if economic growth is to be sustained. Regulatory reform and innovations in medical science and technology are key to addressing these challenges. In this present scenario the Drug companies and other big businesses have now begun to dominate the private health sector, with five-star hospitals providing services which only foreigners and the richest Indians can afford. The Govt should aim to create an insurance scheme for poor families and increase health spending. India’s health sector faces several key issues respective roles of the public and private sectors, budget and resource allocation, management of health services, quality of care, and work force. The Union and State Govt should address these issues, and by implementing various programs to adjust the health strategy and the technical paradigms.

Since 1991, the World Bank Group has significantly increased its emphasis on health sector development in India. The Bank has been working to help India reduce the level of mortality, morbidity and disability through taking various programs in its hand.

India must improve its healthcare sector to realize its economic potential. The problems are huge and many in numbers but it cannot be said impossible to resolve if the Govt, civil society and legislations will work together for all. A lack of qualified medical personnel is a serious problem. Public- private partnership programme can open new paradigms for India’s future and can ensure programmes like National Rural Health mission to be succeeded.  Subsidizing healthcare and insurance for poor is necessary to improve general condition of the poor at large. We have three priorities, such as increasing the availability of care, access to affordable care and awareness of healthy behaviour and the healthcare resources available to Indians can be addressed successfully if the whole society will work together. Sustainable economic development in India will require more than just a growing economy. Investment in human capital, and in keeping Indian society as a whole safe from potentially large- scale health threat will help the country to maximize the potential of its most productive resource- the ingenuity and creativity of its people.