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Healthcare takes centre stage, finally! 173

much higher healthcare investments and concomitant health infrastructure have struggled to
contain the pandemic. The next health crisis may not possibly involve a communicable disease.
Therefore, India’s healthcare policy must continue focusing on its long-term healthcare priorities.
Simultaneously, to enable India to respond to pandemics, the health infrastructure must be agile.
For instance, every hospital may be equipped so that at least one ward in the hospital can be
quickly modified to respond to a national health emergency while caring for the normal diseases
in usual times. Research in building such health infrastructure can guide how to build such
flexible wards.

5.38 The ongoing COvID-19 pandemic has helped showcase the role of technology-enabled
platforms as an alternate distribution channel for remote delivery of healthcare services. These
technology-enabled platforms offer a promising new avenue to address India’s last-mile
healthcare access and delivery challenges. These technology platforms coupled with digitisation
and the promise of artificial intelligence at-scale, have led to a drastic uptake in the utilisation
of telemedicine for primary care and mental health. Given India’s unique last mile challenges,
such technology-enabled solutions need to be harnessed to the fullest. As we show, telemedicine
depends crucially on internet connectivity and health infrastructure. Therefore, both Central
and the State governments need to invest in telemedicine on a mission mode to complement the
government’s digital health mission and thereby enable greater access to the masses.

5.39 The National Health mission has played a critical role in mitigating inequity in healthcare
access. The percentage of the poorest utilising prenatal care through public facilities has increased
from 19.9 per cent to 24.7 per cent from 2004 to 2018. Similarly, the percentage of the poorest
accessing institutional delivery increased from 18.6 per cent to 23.1 per cent and from 24.7
per cent to 25.4 per cent for post-natal care. The poorest utilising inpatient care and outpatient
care has increased from 12.7 per cent to 18.5 per cent and from 15.6 per cent to 18.3 per cent.
Therefore in conjunction with Ayushman Bharat, the emphasis on NHM should continue.

5.40 From a financial perspective, India has one of the highest levels of OOPE in the world,
contributing directly to the high incidence of catastrophic expenditures and poverty. A negative
correlation exists between the level of public spend and OOPE both across countries and states.
In fact, at small levels of public spend (less than 3 per cent of GDP), even marginal increases
in public spend generate substantial “bang for the buck” in reducing the OOPE. An increase in
public spend from 1 per cent to 2.5-3 per cent of GDP – envisaged in the National Health Policy
2017 – can decrease the OOPE from 65 per cent to 30 per cent of overall healthcare spend.
As Chapter 9 in this volume shows, PMJAY has been a marquee evolution in this direction,
providing financial affordability to a large percentage of the Indian population.

5.41 As a bulk of the healthcare in India is provided by the private sector, it is critical for
policymakers to mitigate information asymmetry in healthcare, which creates market failures
and thereby renders unregulated private healthcare sub-optimal. Therefore, information utilities
that help mitigate the information asymmetry can be very useful in enhancing overall welfare.
The Quality and Outcomes Framework (QOF) introduced by the National Health Service (NHS)
in the United Kingdom 2004 as well as other quality assessment practices introduced by NHS
provide a good example in this context. These should be evaluated carefully and considered for
implementation. Similarly, data from the National Digital health mission can be utilised even