At the ninth Kolkata Group Workshop, chaired by Professor Amartya Sen, 45 participants from different walks of life, including social scientists, policy makers and development experts, convened to assess the dimensions of social equity in India especially as related to poverty, elementary education, and health.
Participants assessed that the benefits of economic growth over the past two decades, while substantial, have not translated into health security for people. They analysed that many countries in Asia, including even those with lower per capita income, are tending to outperform India in health and healthcare. “India lacks a primary healthcare system that offers effective and affordable protection to all against common illnesses. India’s public spending on health — a little over one percent of GDP — is among the lowest in the world. This has led to an extremely high burden of private out-of-pocket health expenditures, which a huge part of the population cannot afford, and which even fails to guarantee reliable healthcare because of inescapable difficulties of the market for medical attention and care,” the participants discussed.
The group called upon India’s leaders to recognise the necessity for the state to provide comprehensive quality primary health care for all.
Influential policymakers in India seem to be attracted by the idea that private healthcare, properly subsidised, or private health insurance, subsidised by the state, can meet the challenge.
However, there are good analytical reasons why this is unlikely to happen because of informational asymmetry (the patient can be easily fooled by profit-seeking providers on what exactly is being provided) and because of the “public goods” character of healthcare thanks to the interdependences involved. There are also major decisional problems that lead to the gross neglect of the interests of women and children in family decisions. Nearly every country in the world which has achieved anything like universal health coverage has done it through the public provision of primary healthcare (whether in Europe, Canada, or much of East Asia).
Related to the main focus of the recommendations, the Kolkata Group urged the government to increase public spending on healthcare to achieve its well-considered pledge of devoting at least three per cent of GDP to healthcare.
It is particularly important to recognise that there are good reasons for demanding universal entitlements to publicly provided primary healthcare for all, discussed the participants.