Government think tank Niti Aayog released a report ‘Health Systems for a New India: Building Blocks—Potential Pathways to Reforms,’ on Monday in New Delhi.

The report, synthesis of one-year long exercise, was released by Niti Aayog Vice Chairman Rajiv Kumar in the presence of co-founder of Microsoft and co-chairman of Bill and Melinda Gates Foundation, Bill Gates.

Focus areas

The report identified five focus areas of future health system - to deliver on unfinished public health agenda, change health financing away from out of pocket so spend into large insurers, integrate service delivery vertically and horizontally, empower citizens to become better buyers of health, harness the power of digital health.

The report on the outset criticizes multiplicity of health schemes saying, “Imagine a billion transactions every year where individual patients seek care from a million healthcare providers dominated by the private sector negotiating their own prices for the procedures they undergo. Even among organized players, there are multiple schemes. Multiplicity of purchasing platforms, apart from fragmenting risk pools into sub-optimal sizes, prevents standardization of purchasing procedures and imposes a huge compliance burden on the providers.”


Niti Aayog has recommended that health system financing structure should be changed in such a way that predominant undesirable out-of-pocket expenditure is reduced and spending is directed towards larger risk-pools with strong strategic purchasing capabilities. It has stressed on best practices adopted by Suvarna Arogya Suraksha Trust of Karnataka launched in 2010, which went on to empanel hospitals from neighbouring states, for patients living in border areas for their state health insurance scheme and are now aiming for providing the health scheme for their entire 6.4 crore population. Karnataka is also looking at bringing all schemes under a single umbrella. Another example, that has been cited for it’s best practices is Meghalaya.

Other suggestions

Even as the report has not out rightly suggested that Pradhan Mantri Jan Arogya Yojana (PM-JAY), government’s cashless health insurance scheme covering 10 crore poor families for Rs five lakh annually, should be extended to whole of India, it discretely mentioned that PM-JAY should be considered with an eye on its potential to influence the overall healthcare transformation in India, beyond its current explicit mandate.

“At a systems level, overcoming the challenges of fragmentation, across healthcare financing and service delivery, will help us optimize both quality and access. India now needs to build on its many opportunities to achieve further progress on the health of its citizens and respond to the growing aspirations and needs of a new India,’ said Rajiv Kumar, Vice Chairman, Niti Aayog.

Bill Gates, co-chairman of Bill and Melinda Gates Foundation said, “Primary healthcare is extremely important for all. India is in a very hopeful situation and is set to be an example for other countries. He mentioned that the private sector needs to be involved to meet key challenges and that the Gates Foundation through its initiatives will extend all possible help.”

With insights to transform the Indian health system in the twenty-first century, the report presents a preliminary menu of strategic choices available before India to reform its healthcare system.

The report has drawn from best practices of countries as diverse as Cambodia, Thailand, China, Russia, UK, US among the others for India to learn from.