A blueprint to make healthcare delivery more transparent, accessible

It is being called the “Mumbai Declaration”. A pledge to prioritise healthcare and universal health coverage and has been taken up by a cross section of people involved with healthcare delivery.

At the top of this list of objectives is to get the Centre to increase funds for healthcare from 1.4 per cent to of GDP 3 per cent, and to also make States contribute more.

Close on the heels of this Declaration made at the Tata Memorial platinum jubilee event came Budget 2017. And it revealed no such increase in healthcare spending by the Government.

But Rajendra Badwe, Tata Memorial Centre’s Director, is optimistic that the concrete steps being laid out will yield results.

Each objective mentioned in the Declaration will be classified into areas that will be outlined in greater detail and sent to the Health Ministry in a month, says Badwe, when asked how they plan to translate intent into action on the ground.

The Declaration lists a dozen objectives, including reducing out-of-pocket expenditure by patients, curbing healthcare costs by stopping unethical practices, and ensuring that healthcare providers adhere to quality, are transparent in their dealings and stick to evidence-based guidelines. Giving the example of his hospital on the objective of reducing out-of-pocket expenditure, Badwe says that in the Tata Memorial model, several drugs and treatment modalities are subsidised 85-90 per cent and in other cases 20-25 per cent. There are different categories and patients seek treatment accordingly, he explains of a model that can be replicated by other hospitals.

Union Health Minister JP Nadda, who participated in the event, also pledged support by committing his Ministry to implementing “in letter and spirit” every suggestion of the Mumbai Declaration.

CS Pramesh, TMC’s Professor and Chief, Thoracic Surgery (Department of Surgical Oncology), explains that once a detailed plan is submitted to the Ministry, a critical mass would be generated through a combination of support from the Government and peer pressure in the industry.

There are several spokes to universal healthcare and access is one part of it, explains Pramesh, pointing to quality control and assurance, medical audits and so on. Healthcare delivery involves hospitals, non- governmental organisations, corporates, etc. The Declaration is a “blueprint of actionable points” that takes into account various issues involved in healthcare.

Take quality, for instance. There are no standards, accreditation is not mandatory or its expensive. The idea is to have a basic set of standards and make the process transparent, says Pramesh.

On funds for healthcare in a country like India, there isn’t a limitless pot of money. And add to this the limited penetration of health insurance and other concerns over the misuse of funds. Guidelines need to be put in place for the transparent use of funds, on governance involving medical audits to regulate healthcare and so on.

The Declaration is being fleshed out with “feasible and practical” details, links to institutions and timelines, says Pramesh. Effort is also to get hospitals, insurance companies, doctors, and others on board to implement and make healthcare delivery more transparent and equitable. But once the detailed Declaration is submitted, that’s when the task becomes real uphill .

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