Earlier this year, the Centre revised India’s national healthcare policies with two aims in mind: lowering healthcare costs and strengthening the system of primary care. A two-article deep dive, published recently in the international medical journal, The Lancet, explore the current state of healthcare and its reforms in India; below, we summarize its conclusions.

Lowering medical costs

So far, the Centre has focused on lowering medical costs through expanded subsidies and benefit programs, such as the National Health Mission (NHM) Free Drugs Services Initiative and NHM Free Diagnostics Initiative, which aim to cover the costs of essential medications and diagnostics, and the National Dialysis Programme under the flagship NHM, which aims to underwrite dialysis treatment for low-income patients. It has also moved to expand price caps on critical medical devices and reduce drug prices.

But, according to reporting by Patralekha Chatterjee, a lack of awareness of these benefits and emergency resources, like the Prime Minister’s National Relief Fund (PMNRF) and the Health Minister’s Cancer Patient Fund (HMCPF), still dogs the poorest patients, who continue to pay high out-of-pocket prices.

Critics say there’s a large private sector component to lowering healthcare costs that hasn’t been tapped into. Per Keshav Desiraju, a former health secretary in the Centre:

“The National Health Policy has very good statements, but the government doesn’t have the resources.” The government will need to draw in private resources to help it achieve national objectives. “In public-private partnerships, there needs to be much more clarity on what the private party is getting out of this. The patient is not supposed to pay when he/she walks into a government health facility and he/she should not pay in a health facility run on partnership.”

Expanding primary care

Expanding primary care, that is, the first point-of-contact with healthcare, particularly to rural areas, has been another guiding principle of the Centre’s activities, and there’s no doubt it’s needed. But the quality of that expansion and its ultimate beneficiary is questionable. Since 2014, the Centre has rolled out several new AIIMS; however, the report notes, the quality of these new institutions has been questioned. And it remains to be seen whether more doctors will result in expanded care, or simply a surplus of practitioners in urban areas.

There’s also the question of what primary care should constitute. The National Programme for Prevention and Control of Cancer, Diabetes, Cardio-vascular Diseases and Stroke (NPCDS) is evidence of the Centre’s focus on non-communicable diseases – a disease burden expected to increase steeply as India’s population ages. It’s a foresightful approach, but perhaps too foresightful. In the immediate future, healthcare needs vary vastly between states; while more broadly developed states like Kerala, where NCDs associated with wealthier, urbanized and sedentary lifestyles are fast becoming a top public health concern, other states, like UP, are still struggling with the basics of infant and maternal mortality, malnutrition, and sanitation.

This trade-off is, of course, inherent in public healthcare system reform anywhere. And there are signs the gap can be filled – states like Tamil Nadu, Kerala and the Punjab are stepping in to tailor universal health interventions more suited to their needs. But there’s only so much states can do. And with only 2.5% of GDP dedicated to public health by 2025 (admittedly, more than a doubling of the Centre’s current investment, but still a far cry from the 6% most other, less developed countries invest at the national level), The Lancet concludes what most on-the-ground already know: the reforms are far from the end of the story.