HOPS as a route to universal health care

Context: The basic idea of Universal Health Care (UHC) is that no one should be deprived of quality healthcare for the lack of ability to pay. In the Bhore Committee report of 1946, a case was made for India to create its own National Health Service (NHS) type health care system.  

How UHC can be achieved? 

It relies on one or both of two basic approaches: public service and social insurance.  

In the first approach, health care is provided as a free public service. The second approach allows private as well as public provision of health care, but costs are mostly borne by social insurance fund(s), not the patient.  

The social insurance model allows private as well as public provision of health care. However, the costs are mostly borne by the social insurance fund(s), not the patient. Insurance is compulsory and universal, financed mainly from taxation, and run by a single non-profit agency in the public interest. For ex – Canada, Australia, and Taiwan. Other countries have multiple players, for example – Germany.  

What are the challenges? 

In the social insurance system, public service plays an essential role. There is a need for public healthcare centers to prevent wasteful expenditure.  

Another challenge is regulating private health-care providers. As they have a conflict between the profit motive and the well-being of the patient.  

In this case, the National Health Service model, it needs to have not only good management and adequate resources but also sound work culture and professional ethics. India’s public health services do not have a good record on this part.  

What can be the possible route to UHC for India today? 

It can be called “healthcare as an optional public service” (HOPS). The idea is that everyone would have a legal right to receive free, quality health care in a public institution if they wish. The public sector would guarantee decent health service to everyone as a matter of right, free of cost.  

For example – In Kerala and Tamil Nadu, most illnesses can be satisfactorily treated in the public sector.  

HOPS is not as egalitarian as the NHS or insurance model. But it would be a big step toward UHC. Social insurance can also play a limited role in covering procedures that are not easily available in the public sector. 

The main difficulty in HOPS is to specify the scope of the proposed healthcare guarantee, including quality standards.  

Way forward: 

A Right to Health Bill would be an invaluable affirmation of the State’s commitment to quality health care for all. Tamil Nadu is well placed to make HOPS a reality under its proposed Right to Health Bill.  

Source: This post is created based on the article “HOPS as a route to universal health care” published on 13th April 2022 in The Hindu.