Transforming health care access and empowering communities

Life expectancy and access to health care have increased globally in recent decades, which has significantly improved general welfare. Consequently, health care reforms have become increasingly important worldwide to improve accessibility, affordability, and the quality of services, as well as spending efficiency. While the primary health benefits of health schemes are fairly well-documented and discussed quite often by policymakers and scholars, the secondary health benefits of such schemes rarely get attention. It is in this light that, through this article, we seek to contribute to efforts aimed at recognising the importance of health schemes for achieving inclusive and equitable development that impacts entire societies.

Ayushman Bharat, as one of the largest government-funded health care programmes, aims to address these challenges by providing comprehensive health coverage. The Pradhan Mantri Jan Arogya Yojana (PM-JAY) under Ayushman Bharat seeks to reduce financial hardship by covering hospitalisation costs for nearly 500 million beneficiaries. Its impact extends beyond health care, fostering local economic development, creating jobs, and promoting social equity.

Apart from the primary health benefits, the Ayushman Bharat scheme has extensive secondary benefits, such as employment opportunities, local partnerships with communities, decreased inequalities, and population-level impacts on socio-economic development. These include women empowerment, increased literacy and school completion rates, and decreased out-of-pocket expenditure. The economic impact of investing in health systems by creating high-quality jobs and purchasing goods and services from local businesses highlights the second-order health advantages. Not only do healthcare systems play an important role in the national economy, but also in the social lives of communities.

India's fertility rate has fallen below the replacement level, a trend that's both surprising and concerning for the world's most populous nation. While a declining fertility rate is often associated with economic growth and development, it also poses significant long-term demographic challenges. One critical issue is leveraging the benefits of India's demographic dividend. India's fertility rate dropped from nearly 6.2 in 1950 to just under 2 in 2021, and it is projected to fall further to 1.29 and 1.04 in 2050 and 2100, respectively, according to industry studies. Simultaneously, the ageing population will require enhanced healthcare and social support systems, which could strain the economy and productivity. This paradox raises critical questions about India's preparedness to address these challenges and capitalize on the opportunities that come with an aging population.

The World Health Organization (WHO) states that a health care system should improve population health, prevent health care costs, and meet health expectations. Risk sharing and financial protection are crucial since healthcare is expensive and uncertain. Responding to people’s expectations shows respect for dignity, autonomy, and information confidentiality. Improving health means increasing the population’s average health and reducing health disparities. With India's fertility rate declining, it becomes even more critical to integrate fertility-related healthcare into the larger health insurance framework.

A recent study in Lancet has not only warned of the declining fertility rates but also has stressed on affordability of fertility treatments for the underprivileged patients. Government policies and insurances should, therefore, consider these changes to make it more affordable.

Including fertility treatments and reproductive health services in the health insurance framework can have profound socio-economic benefits. Fertility issues affect many families, and providing coverage for treatments can reduce financial stress and support population health.

• Improved access to fertility treatments: By including fertility services in health insurance, more families can access necessary treatments, reducing the emotional and financial burden of infertility.
• Enhanced maternal and child health: Comprehensive coverage ensures that mothers receive adequate prenatal and postnatal care, leading to healthier pregnancies and better outcomes for children.
• Population health management: Addressing fertility issues as part of the health insurance framework supports population health management, ensuring a balanced demographic dividend, and reducing the risks associated with declining fertility rates.

Investing in health systems not only supports economic growth through the creation of high-quality jobs and local procurement but also enhances social cohesion within communities. By fostering partnerships and employing local resources, health systems play a pivotal role in both the economic vitality and social fabric of communities.

The World Health Organization emphasises that health care systems should improve population health, mitigate financial risks, and meet public health expectations. Risk-sharing and financial protection are crucial given the unpredictability and expense of healthcare. Responding to these expectations underscores respect for dignity, autonomy, and confidentiality in health care provision. Improving health outcomes contributes to raising average population health levels and narrowing health disparities.

In conclusion, this report underscores the significant socio-economic impacts of health schemes and advocates for recognising the indirect contributions of health systems to various facets of community development. It underscores the need to view health systems not just as providers of health benefits but as catalysts for broader economic and social progress, benefiting diverse segments of society, particularly those historically marginalised.

This article is authored by Dr Sonia Malik, chief clinical mentor and Shobhit Agarwal, CEO, Nova IVF Fertility.