This Article is written by
Arpan Anand – 2nd Year of BBA LL.B.
Bharati Vidyapeeth,(Deemed to be University),New Law College Pune.
Abstract
Health care is a key element of what shapes human well being and social economic growth. It plays very much into how we see greater life span but also better productivity and equity within our societies. In the European Union we see a large scale example of health care delivery which also includes the Indian case study a very diverse and developing country which is at the fore front of equal access, and at the same time we have the EU which is a group of very advanced economies with very well developed welfare systems. This article does a study which looks at the health care systems in the EU and in India, at their past development, structure, what which funds them, access to care, technology use, preventive health care and also the issues they are present with. We put forth that while India may take from the EU in terms of universal health care, funding models and preventive care the EU in turn has much to learn from India’s health tech innovations and it’s affordable pharmaceutical industry. This comparison also brings to light the requirement for health care policies which are adaptive, inclusive, and resilient which in turn will address local as well as global issues.
Keywords: Healthcare, India, European Union, Universal Health Care, Health Financing, Public Health, Digital Health, Comparative Policy.
Introduction
Health care is out of the question of medical care it is a social right and an instrument for justice, equality, and development. What a country is able to do about health care access and equity is a measure of its good governance and social contract. In the case of India’s 1.4 billion people we see very special issues of scale, diversity, and disparity.As for the European Union which although made up of very different member states has for the most part made health care a guaranteed right of citizenship which is supported by robust financing and regulatory frameworks.
In looking at India and the EU we see how different settings play out in terms of health care results and also which strategies may be put forth by both that will improve health care in the future.
Historic Development.
India
After World War II, India was confronted with great health issues which included high infant mortality rate, malnutrition, and wide spread communicable diseases like malaria and tuberculosis. The Bhore Committee of 1946 put in place the base for a comprehensive public health structure which put forward the idea of universal primary health care. Over the years India introduced national programs like the National Rural Health Mission in 2005 and later the National Health Mission in 2013 which had the goal of improving maternal and child health. But also here we see that there was chronic low funding and a large scale private health care which grew at a fast pace creating a two tier system well equipped private hospitals for the which the affluents go to and very under served government health care for the rest.
European Union
The post World War II era saw the birth of the European health care model which included the introduction of the National Health Service in countries like the UK. In Germany and France we see expansion of their social health insurance models which built on pre war welfare institutions. Over time health care became a central element of the European welfare state which was based in the principles of solidarity, equity, and social rights. Although there is no one health care system across the EU, the European Commission pushes for health care cooperation, funding, and regulation to maintain high health standards.
Healthcare Structure of Health Systems.
India
India follows a tiered system: India has a tiered system:.
Primary care: Delivered in to Sub-Centres, PHCs, and CHCs which serve as the primary point of contact for rural areas. But many of these centers report issues with regard to doctor and medicine shortage as well as equipment.
Secondary care: District hospitals offer specialist care but at the same time are dealing with issues of over crowding and infrastructure deficiencies.
Tertiary care: Medical facilities in metro areas do advanced care which in large part is for the urban elite.
In the private sector which is the primary player in health care delivery at 70% of all services.Although we have advanced technology in this sector it also is very expensive which in turn creates large health care inequalities.
European Union
The EU is a diverse structure which has 2 primary models.
1. In the case of the Beveridge Model which is tax funded health care we see this in countries like the UK, Spain, and Italy which have public hospitals and general practitioner based health care systems.
2. In many European countries including Germany, France and Belgium health care is covered by mandatory insurance which is funded by employers and employees.
Both models do provide for a citizen’s right to health care, what is true is that the degree of privatization and which elements of choice present for the patient varies. Also it is of note that in EU countries they put an emphasis on the integration of primary, secondary and tertiary care which in turn provides for more smooth patient flow as compared to India’s which is a more broken up system.
Health Care Financing.
India
India invests at a rate of only 2.1% of GDP in public health which is below the global average. This low investment causes citizens to turn to private spending which in turn makes out of pocket expenditure (48% a primary factor in poverty.) While we see initiatives like Ayushman Bharat PM JAY as large steps toward Universal Health Coverage (UHC) which put forward annual insurance of 5 lakh per family that is a great start. But also we see that there are still large gaps in coverage and that many middle income families are left out of government programs which also are not able to afford private care.
European Union
The in average the EU spends 9 11% of GDP on health care which reflects its great interest in public welfare. We see that funding comes from tax or social insurance which in turn protects citizens from health care related financial ruin. Also out of pocket spending in most EU countries is below 20% which we see to be a low number when we compare to India’s burden. Also it is important to note we have cost sharing via co payments which we see do not in fact make care out of reach for most, which is a large issue in India. This strong financial protection what we see in the EU’s health care systems’ makes them very resilient in comparison to India’s which is a more financialy divided model.
Access and Inclusion.
India
Healthcare access in India is very uneven:.
Urban–Rural Divide: In that which is today 65% of Indian population lives in rural areas but in the urban centers you find the bulk of the health care infrastructure and providers.
Human Resource Shortages: India reports a doctor to patient ratio of 1:834 which is below WHO standards. We also see that nursing staff is in short supply.
Socio-economic Inequalities: Marginalized groups which include Dalits, Adivasis, and urban poor are at the receiving end of discrimination and neglect in health care.
European Union
In the EU universal health care is a legal right. Although there are differences between West and East which in some cases do not favor the East, basic services are provided for all. Overall patient satisfaction is high we see that out also in that at large — there are issues with wait times which is a issue in the case of the UK’s NHS for example. Also we see that in general cost is not a issue which in turn makes the system much more fair as opposed to that of India.
Technology’s Role in Innovation.
India
India has become a world leader in digital health. In the case of Ayushman Bharat Digital Mission (ABDM) we see a developing of a national health IT infrastructure which includes digital IDs for patients, electronic health records and telehealth services. Also we have seen platforms like e-Sanjeevani which have made over 140 million telehealth visits, which in turn has helped to bridge the health care gap in rural areas. Also the pharma industry in India is a base for low cost generic drugs which in turn not only fulfills the domestic health drug requiremments but also is a large scale global supplier of affordable medicine.
European Union
The EU is a heavy investor in AI, biotechnology, and digital health. We see the launch of the European Health Data Space (EHDS) which is aimed at harmonizing health data which crosses borders, which in turn is also going to better support patient mobility and research excellence. Telemedicine and robotics are also very much a part of what goes on in EU hospitals. Also while India is focused on scale and affordability, the EU is into interoperability, privacy, and state of the art research.
Public Health and Primary Prevention Care.
India
India has seen great progress in communicable disease control. The Universal Immunization Program got rid of polio and saw a drop in measles. We see campaigns like TB-Mukt Bharat which aim to eliminate tuberculosis by 2025. But India is now seeing a rise in non-communicable diseases cardiovascular diseases, diabetes and cancer which account for over 60% of deaths. Also preventive health care is weak with limited screening and poor lifestyle interventions.
European Union
Cancer screens, vaccination programs, public health and wellness campaigns which include mental health also in the case of an aging population what we see is that preventive care is put in place to catch issues at the earliest stage which in turn reduces total term costs. As for lifestyle based campaigns like anti smoking and obesity we see they are more systemically implemented in this setting as compared to India.
Issues.
India
Underfunding: Public spending does not match population.
Infrastructure gaps: PHCs and CHCs are underfunded.
Human resources: Doctor and nursing shortages.
Inequality: Rural poor and underprivileged communities left out of quality care.
Financial burden: High out of pocket costs are still putting people into poverty.
European Union
Ageing Population: Rising elderly care costs strain budgets.
Chronic Diseases: Lifestyle related diseases on the rise.
Waiting Times: NHS and also other Beveridge models are delayed.
Sustainability: In economic hard times we see that which is required for universal access is a challenge.
Lessons for India from the EU.
1. Raise Public Spending: Increasing health spending up to 5% of GDP would see better health infrastructure.
2. Expand Universal Coverage: Expand PM-JAY to include all citizens.
3. Preventive Health: Implement regular screenings and lifestyle interventions.
4. Health Workforce Planning: Implement European style medical education and retention programs.
5. Integrated Systems: Improve the flow between primary, secondary and tertiary care.
What the EU can see in India.
1. Digital Health Scale: India’s ABDM is a model which has proven large scale digital health implementation at low cost.
2. Affordable Medicines: India’s generic drug model is a solution for EU drug expenditure.
3. Community Health Models: India’s ASHAs and community health workers report to do excellent grassroots work which the EU may do well to look to in their own migrant and rural health care efforts.
Conclusion
India is growing access in the face of issues related to funding, equity, and infrastructure which at the same time see Europe maintaining its universal health care models which it is putting under a financial sustainability and age care pressure. Both are at a point where they may benefit from each other India could see value in the EU’s financing and preventive approaches and the EU in turn may look to adopt some of India’s low cost interventions and grassroots methods.
Healthcare should be recognized as a right instead of a privilege and we see great value in global cooperation which is key to achieving health equity in the 21st century.
References
1. World Health Organization. World Health Statistics 2023: Monitoring Health for the SDGs. Geneva: WHO, 2023.
2. Government of India, Ministry of Health and Family Welfare. National Health Policy 2017. New Delhi: MoHFW, 2017.
3. European Commission. State of Health in the EU: Companion Report 2023. Brussels: Publications Office of the European Union, 2023.
4. OECD & European Observatory on Health Systems and Policies. Health at a Glance: Europe 2022. Paris: OECD Publishing, 2022.
5. Lahariya, C. “Health System Reforms in India: Ensuring Quality, Equity and Affordability.” Indian Journal of Public Health 64, no. 1 (2020): 1–9.
6. Karan, A., Yip, W., & Mahal, A. “Extending Health Insurance to the Poor in India: An Impact Evaluation of Rashtriya Swasthya Bima Yojana on Out of Pocket Spending for Healthcare.” Social Science & Medicine 181 (2017): 83–92.
7. Wismar, M., Palm, W., Figueras, J., Ernst, K., & Van Ginneken, E. (eds). Cross-Border Health Care in the European Union: Mapping and Analyzing Practices and Policies. Copenhagen: WHO Regional Office for Europe, 2011.
8. Patel, V., Parikh, R., Nandraj, S., et al. “Assuring Health Coverage for All in India.” The Lancet 386, no. 10011 (2015): 2422–2435.
9. Busse, R., Klazinga, N., Panteli, D., & Quentin, W. (eds). Improving Healthcare Quality in Europe: Characteristics, Effectiveness and Implementation of Different Strategies. Copenhagen: WHO Regional Office for Europe, 2019.
10. National Health Authority (India). Ayushman Bharat Digital Mission: Strategy Overview. New Delhi: NHA, 2022.
