After distinguishing between the terms “ social medicine ”, “ socialized medicine ” and “ socialization of medicine ” in the previous columns, this concluding piece on the subject will attempt to explore the possibilities of socialization of medicine. in our local sociopolitics. and national contexts to establish a roadmap to overcome statistics of inequitable access to a whopping 65% of our total population. Here, the term “socialization” has been used in the specific context that everything in an egalitarian society is done and achieved through the cooperative and collaborative efforts of its people and citizens, as envisioned in the conventional ideology of “socialism. “. The main objective of public ownership of universal health care is to ensure social justice, security and solidarity so that health services meet the needs and aspirations of the general population and that these services are distributed equitably among all strata of society. This essentially means that universal health coverage for all inhabitants of a nation or community must be financed by the people themselves rather than by the government alone in order to make it sustainable and successful forever. External funding or government funding alone can only support such an initiative for a limited period, not forever. Ideally, pooling resources from government, households, taxpayers, NGOs (where available) and insurers (wherever they loop) can extend the reach of coverage to a broad segment of the population. the population for an extended period.
In order to make substantial progress in our march towards the socialization of medicine leading to universal health coverage (UHC), we must evolve our health financing systems, eliminate or substantially reduce direct payments to people at the point of delivery and expand progressive compulsory prepayments through various forms of taxation, including compulsory health insurance contributions based on ability to pay, although services should be provided equitably to all citizens, regardless of their ability to pay. This was also considered in a resolution adopted by the World Health Assembly in its 64e meeting held on May 24, 2011 which calls for a mechanism for pooling risks and resources among the population in order to subsidize the cost of services and avoid catastrophic health expenditure and impoverishment of individuals, especially the layers poor and marginalized in society while seeking necessary health care (WHA, 2011). While managing the transition of our health system to universal coverage, all available options must be carefully weighed, analyzed and developed in accordance with the specific epidemiological, macroeconomic, socio-cultural and political context of each state in the country.
The first step in the process will be to promote the efficiency, transparency and accountability of our health financing governance systems. This will logically be followed by building and strengthening our institutional capacity to generate regional evidence and effective, evidence-based policy decision-making on the design and implementation of universal health coverage systems, which includes the monitoring of health expenditure flows through the application of standard accounting standards. In addition, we must ensure that our overall allocation of resources strikes an appropriate balance between health promotion, disease prevention, health care delivery and rehabilitation. Where possible, we should take advantage of existing opportunities for collaboration between public and private providers and health financing organizations, albeit under overall government stewardship (WHA, 2011). It is difficult to achieve UHC if the rights of citizens depend solely on the individual contributions made by them, as those who need it most will remain without adequate coverage in such a scheme. It will be difficult to collect direct taxes such as income tax or compulsory health insurance contributions where a large proportion of the population does not have regular paid employment. Therefore, we need to weaken or even break the link between entitlement and contributions and rely more on general budgetary revenues mainly from indirect taxes, designed to be progressive and persistent in nature (WHA. After many years of trying to expand coverage for the informal sector with a contributory, government-subsidized voluntary health insurance program, Thailand abandoned this approach in 2002, introducing a scheme entirely funded by general tax revenues (Prakongsai et al, 2009).
Sufficient government funding or public funding is essential to subsidize the costs of care for the poor and sick. This requires increasing public spending on health, either by prioritizing health financing in national budget allocations, by increasing the overall level of public revenue through progressive and sustainable mechanisms and spending, or by implementing a combination of both. For example, Mexico’s commitment to move towards UHC resulted in an increase in public health spending of 5% on average per year from 2000 to 2006 (Garcia-Diaz et al, 2011). Likewise, increases in public health spending by Turkey between 1995 and 2010 have contributed immensely to significant improvements in their service delivery in addition to better access for underserved and rural populations (worldbank.org). There is a need to build and consolidate pools that cover people from different economic strata and health status to enable the redistribution of resources as the fragmentation of risk pools inhibits our ability to distribute prepaid health funds as needed. . Attempts to split health insurance schemes for civil servants or formal sector workers by countries like Thailand and Mexico before extending explicit coverage to the rest of the predominantly poor population have proven expensive and their governments were forced to spend more resources to gradually equalize benefits across the population.
An important measure required to ensure the successful implementation of UHC is to improve the efficiency of our pharmaceutical supply chains with a view to conserving our limited resources and ensuring their best use to achieve UHC. The World Health Organization has estimated that 20% and 40% of health spending is wasted in most countries because of spending on brand-name drugs rather than buying their generic versions. Purchasing health services efficiently can improve efficiency and save funds that can be reinvested to increase the coverage and quality of health care. Such a strategic purchase involves moving from conventional bureaucratic resource allocation processes to data-driven approaches that use information about the performance of the service provider or the health service needs of the population it serves (Kutzin et al, 2009). While health system financing is an essential component of UHC, progress towards UHC also requires coordinated actions between the pillars of the health system, with particular attention to strengthening human resources for health.
Therefore, the socialization of medicine encompasses a system in which the entire population of a nation contributes significantly, according to their income, social status and resources, to the financing of the health system by through a fair and streamlined tax system so that the poorest and marginalized segments of society are adequately covered for their needs. expenditure on health and do not incur catastrophic expenditure leading to their impoverishment or deprivation of necessary care. In the process, the taxpayers themselves are adequately covered for a considerable number of services and the extent of costs while visiting the health centers, thus getting rid of the stress caused by such personal expenses at the point of delivery. Thus, by socialization we mean the centralization of the pooling of resources and the decentralization of service delivery, where a wealthy part of society bears the burden of health care from disadvantaged, disadvantaged and marginalized parts. The socialization of medicine through UHC implies that all people have access, without any discrimination, to necessary basic health services, promoters, preventive, curative, palliative and rehabilitative, as well as essential drugs, safe, affordable, efficient and of high quality. This can be achieved by making important policy choices and inevitable trade-offs between how mutual funds are used to extend coverage to people who were not previously covered, to services that were not previously covered, or to reduce costs. direct payments. required for each service (WHR, 2010). These dimensions of coverage reflect a set of policy choices regarding benefits and their rationing that are among the critical decisions any country faces in reforming health financing systems towards UHC (end).
(The author teaches pharmacology in the Department of Pharmaceutical Sciences at the University of Kashmir)