National President, IMA
Universal Health Care (UHC)
IMA recognizes Universal Health Care (UHC) as an entitlement to Health security. The
state has an obligation to provide appropriate medical care but also to address all the
health determinants including drinking water and sanitation. The entitlement should be
for a basic Health package for every citizen in primary, secondary and tertiary care.
Universal Health care should be ensured primarily by the public sector supplemented with
strategic purchase from the private sector. Universal Health Care should move from an
aspirational goal to an entitled provision.
Health Financing
IMA advocates a tax-based system of Health financing. Contributory Health insurance
offers incomplete coverage and restricted services. General revenues should be the
source of UHC. Increased allocation of financial resources for Health is the most important
component. The allocation varying from 1.1 to 1.6 % GDP together by the various
Governments is one of the lowest in the world. Moreover, the expenditure incurred on
Health determinants like drinking water, sanitation should be provided for separately.
Thus, the minimum allocation for Health alone should be around 2.5% of the GDP. Despite
numerous policy pronouncements prioritizing health, the governments in India at the
Centre and state levels have historically underfunded the public health sector, resulting
in poor health outcomes and rising inequity in access to health care. India’s overall health
spending (public and private) is currently estimated to be 3.8% of its GDP, lower than the
LMIC average of health spending share of GDP of around 5.2%. India’s health system is
overwhelmingly financed by out-of-pocket (OOP) expenditures incurred by households
(around 63% of all health spending) (NHSRC, 2018b; RBI, 2019). Government funding,
provided by both the Central and state governments, currently constitutes approximately
one-third of all health spending, with states accounting for nearly two-thirds of total
government health expenditure. Sustained underfunding of public sector facilities, and
the rapid growth of private sector has contributed to rising OOP costs on health care for
households. Of this, a significant share, almost two-thirds of OOP expenses, are forpurchasing outpatient care, especially medicines. Because households bear the burden of
the high OOP health expenses in India, more than 55 million people are impoverished
each year on account of expenses for ill health.
Accreditation is better option
The advice of the Planning commission committee to choose accreditation for healthcare
institutions as the choice for regulation was ignored. The Clinical Establishment Act in the
current form is proving to be a burden on small and medium hospitals. Cases of misuse
of power are being reported. If registration and quality are the aims the goals will be
better served by insisting on accreditation rather than regulation. There is a strong case
for exemption of small and medium hospitals from the clutches of the current CEA.
Anti-Microbial Resistance
AMR is emerging as a major threat in the communicable diseases front and has to be
tackled with urgency. Anti-Microbial resistance (AMR) is global, regional, and national
priority. It increases morbidity and mortality, and results in economic losses. The rates of
AMR in the 3 sectors – human, food animal, and environment – have been rising
disproportionately in India in the past decades.The responsible use of antibiotics is a fundamental and effective strategy in containing
AMR; however, misuse, overuse, and inappropriate use of these medications contribute
significantly to the development and spread of antibiotic-resistant bacteria. AMR
containment needs a multi-stakeholder response to raise AMR awareness, training, and
capacity development of health professionals, strengthening of infection prevention and
control, operational research, and surveillance of AMR, as well as antimicrobial
consumption/use and healthcare associated infections.
IMA can play a pivotal role in promoting behavioral change through continuous medical
education, peer support, and fostering of responsible anti-microbial use within the
healthcare community, and reduction of spread of infections in health care settings.
Quality of Drugs and related issues
The Mashelkar Report of 2003 noted, “The problems in the regulatory system in the
country were primarily due to inadequate or weak drug control infrastructure at the State
and Central level, inadequate testing facilities, shortage of drug inspectors, non-
uniformity of enforcement, lack of specially trained cadres for specific regulatory areas,
non-existence of data bank and non-availability of accurate Information. There is much
less quality control on the manufacture of medication except perhaps among those
recognized as GMP (Good Manufacturing Practice) companies. Quality assurance of the
drugs manufactured in the country is a top priority. Similarly, GST on drugs and medical
equipment levied at 5% to 18% needs a reconsideration considering the fact drugs form
the substantial portion of out-of-pocket expenditure.
IMS – Indian Medical Services
The COVID pandemic has exposed the vulnerability of the healthcare system in our
country. It has also brought to fore the grave paucity of professionalism in health
management right from the Sub-District Office level. As such, this mandates towards an
acute need for change in the health administration of the country. IMA has proposed to
the Government to revive the Indian Medical Services discontinued in 1948. An All-India
cadre of doctors would be more sensitive to the needs of the patients and clinicians. It is
pertinent to note that ‘Law and Order’ is a state subject in the schedule appended to the
Constitution of India but there is an All India Indian Police Service which is in vogue.
National Medical Commission
1,08,915 MBBS graduates come out of 706 medical colleges of India posing huge
challenge for quality maintenance in our medical colleges. IMA desires that NMC should
rise to the expectations and trust invested in it. NMC should be sensitive to the issues of
young doctors, their career and unemployment. Moreover, the National Medical
Commission Act, 2019 needs to be amended to suitably incorporate a provision
thereunder for supporting medical education through accruable developmental funds in
tune with the provision included at Section 12(B) of the University Grants Commission
Act, 1956 governing Higher Education so as to make National Medical Commission a
Commission in the truest and realistic sense by vesting it with financial disbursement
authority.
In order to invoke quality centricity in all levels of medical education a robust and
outcome based analytical accreditation system through Autonomous Accreditation and
Ranking Board of the NMC needs to be rolled out immediately in the teeth of recognition
granted to it by World Federation of Medical Education vide its Notification dated 20th
September, 2023 for a period of 10 prospective years and avail much desired Global parity
in the context of the material reality that India turns out to be the largest producer of
trained health manpower.
It is also mandated that institutionalized mechanism in the form of Academic Staff
Colleges for full time faculty development programme through structured refresher
courses for medical education needs to be evoked for fulfilling international parlance on
the said count.
Healthcare violence
Violence on Doctors and Hospitals is a national shame. 23 State legislations have been
ineffective due to absence of a Central Law.
The Central Government deemed it fit to bring amendments to the Epidemic Diseases Act
1897 during Covid period. Airport and Airline staff are protected by a Central Law.
Hospitals should be declared as safe zone. Doctors and nurses deserve to be protected
during normal times as well and certainly deserve to be treated as equivalent to airline
staff.
Health Manifesto
In a Parliamentary democracy the only way to raise our concerns is to sensitise the
common man and create a public opinion. Health of the nation deserves to be an
important election issue and IMA strives to streamline its concerns into a Health
Manifesto. IMA rededicates itself to the health of our people and to work with the
Government to achieve affordable Universal Health Care for everyone.
Priorities
- Tax funded universal healthcare with basic package for all citizens.
- Direct funding of Government Hospitals and human resources with strategic purchase from private sector.
- 5% GDP resources to be allotted by the Governments to Health.
- Re-envision PMJAY to cover OPD care and cost of drugs.
- Direct patients transfer, copayment and reimbursement models will sustain Health insurance model.
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