The forthcoming election is going to be an inflexion point for India’s health system story — how affordable, how accessible, how equal? Though health is not a political priority as yet, two visions of the future health policy seem to be clearly emerging. One, espoused by the BJP — a centralised hospital insurance-driven health system designed on the Medicare model of the US. The other, of the Congress, calling for guaranteeing every citizen with access to essential health services, resembling the UK and the European model. Both these approaches are widely divergent and will profoundly impact the three pillars of the health system — access, quality and affordability.

Given India’s fragile economic system and multiple demands on it, notwithstanding India being the second-fastest growing economy, sustainability will be a major concern. The two thought streams, propounded by the BJP and the Congress, are embedded in and reflect two social value systems: In the US, it is individual liberty and personal responsibility, while Europe and countries like Japan are driven by ideas of social responsibility and state accountability. The emergence of these two ideological streams had their origins in the rise of Marxism in early 19th century and World War II that devastated UK’s economy, to declare that “Individuals should recognise the duty to be well and restoration of the sick person to health is a duty of the state and the sick person. And so universal coverage as a minimum — a solid and level floor, no interior walls and a roof that need not be level but whose height is determined only by people’s own wishes and means”. Read More