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Suggestiion to improve the model

Posted by bijusoman on 20 Jul 2013 at 12:14 GMT

Researchers of this work have done a great service by undertaking this pioneering work. Many groups of researchers are grappling on ways to materialise Universal Health Care in India, so bringing out estimates for curative care needs of the community comes very handy. The article doubtlessly makes it clear that we can fully satisfy medical needs of the society by strengthening our public healthcare system by increasing budget allocation for healthcare to just 3.8% of our GDP. The purpose of this comment is to highlight that the public health advantage of UHC concept would be indeed higher.

Title of the paper states it is a model based estimation of the cost of Universal Health Care, but the model accounts only curative aspects of healthcare. In the spirit of Universal Health Care concept we need to offer entire spectrum of healthcare services, namely curative, personal preventive and the promotive services that comes under the population strategy. Of course, there will be explicit demand for curative services from the public, so it is quite natural that researchers have emphasised it. Detecting and treating diseases in the earlier stage, much before they usually presented to the hospitals will reduce suffering and often will have better prognosis and lower costs. However this high risk approach like screening for hypertension, diabetes, malaria, tuberculosis, etc. are resource intensive.

The real advantage of Universal Health Care lies in population approach which offers preventive and promotive services at the community level. This includes a gamut of activities, both within and outside the ambit of healthcare sector. Anti-tobacco activities, surveillance on infectious diseases, campaign to reduce salt intake and enhance exercise, etc. are examples that could be taken up by the health department. Wider social determinants of health like coverage of water and sanitation facilities, poverty reduction measures, literacy campaign, women empowerment, etc. could be better addressed by civil societies, local governments and other service sectors. Phenomenal achievements are possible with minimal bridge funding of many ongoing initiatives by sectors other than health. Such multi-pronged strategies shall bring down the costs of medical care needs in the long-run.

I do agree that it is difficult to figure out financial obligations such pubic health activities involving varied stakeholders. Earmarking around 30% of the overall costs to public health activities would have made the model more complete and given a strong impetus to the public health argument, as this article would widely be discussed in the policy circles.

No competing interests declared.