Progress & Persistent Gaps
Over the years, India has witnessed significant improvements in its health outcomes. However, the pace of this progress has slowed, and the benefits have
not been evenly distributed. A child born in a disadvantaged district or marginalized community still faces considerably poorer health prospects compared to a child from an urban, middle-class background. Concurrently, there's a steady rise in non-communicable diseases (NCDs) and mental health conditions, alongside emergent threats like climate change and antimicrobial resistance. This situation underscores the critical question: is our current health system adequately equipped to address the health needs of a rapidly changing India, or is it still geared towards past challenges? The experience of beneficiaries, who may have access to insurance cards but lack clear guidance on navigating the treatment pathway, points to a deeper systemic issue beyond mere financial coverage.
Ayushman Bharat: Promise and Limitations
The launch of Ayushman Bharat, the world's largest government-funded health assurance program, was met with skepticism, yet it has achieved remarkable feats. To date, over 10 crore hospital treatments have been facilitated, and an estimated Rs 2 lakh crore has been saved by households through reduced out-of-pocket expenditure. Despite these successes, the system faces considerable limitations. While access to healthcare has widened, the quality and experience of care often remain fragmented and subpar. The system tends to be hospital-centric and focused on curative interventions, neglecting the crucial role of primary care. This foundational level, which should champion prevention, continuity, and trust, remains under-resourced, proving that even the most robust health assurance scheme cannot compensate for weak primary healthcare infrastructure. The focus has been on treatment rather than holistic well-being.
Addressing Underinvestment & Fragmentation
A significant factor contributing to these systemic weaknesses is chronic underinvestment. Public health spending as a proportion of GDP has remained largely stagnant for two decades, exacerbating existing problems. Furthermore, the manner in which funds are allocated—often fragmented across various schemes, departments, and line items with limited flexibility and accountability—further hampers efficiency. The prevailing budgeting methods, such as line-item budgeting in the public sector and fee-for-service payments in the private sector, inadvertently incentivize volume over outcomes. This model encourages episodic treatment rather than fostering long-term health and preventive care, creating a cycle of reactive rather than proactive health management and failing to incentivize providers for keeping patients healthy.
A New Vision: People-Centric Reform
Given these challenges, the Lancet Commission advocates for a fundamental shift, asserting that incremental changes are insufficient. India needs to transition from a fragmented, facility-driven healthcare model to one that is comprehensive, coordinated, and fundamentally people-centered. The emphasis must extend beyond mere coverage numbers to encompass the quality of care, the dignity afforded to patients, and the respect they receive throughout their healthcare journey. This paradigm shift requires empowering states with greater financial autonomy, robust data systems, and genuine decision-making power, while simultaneously holding them accountable for health outcomes. Leveraging India's Digital Public Infrastructure (DPI) offers a powerful opportunity to enhance care continuity, enable real-time health surveillance, and foster learning health systems. However, the effectiveness of these digital tools hinges on underlying principles of trust, sound governance, and strong ethical safeguards.
Private Sector & Governance Reforms
The role of the private sector is undeniably crucial for achieving universal health coverage in India. The Lancet Commission suggests that managed care principles should replace current volume-driven incentives. This approach would emphasize prevention, establish clear gatekeeping mechanisms, define provider networks, and implement rational payment systems. Regulatory frameworks must be designed to foster innovation while robustly protecting the public interest. While many of the Commission's recommendations align with existing policy intentions, the real challenge lies in effective execution. Health governance reform is not merely a technical undertaking; it is an inherently political process that requires navigating complex stakeholder interests and power dynamics to ensure equitable and effective healthcare delivery for all citizens.
