Article: – Achieving Universal Health Care
The article in question, titled “Advancing a Fresh Vision for Universal Health Care,” published in the Hindu on March 20th, 2023, examines the challenges associated with implementing Universal Health Care/Coverage and proposes potential solutions.
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The need for Universal Health Coverage (UHC) is widely recognized globally as an essential component of the development agenda. The Covid-19 pandemic has highlighted the importance of UHC, as health systems failed across the world.
In 2017, the United Nations designated December 12th as International Universal Health Coverage Day (UHC Day) to emphasize the significance of UHC. UHC is defined as ensuring everyone has access to necessary health services without financial difficulty. Sustainable Development Goals target 3.8 aims to achieve universal health coverage, including financial risk protection and access to essential healthcare services, medicine, and vaccines.
Proper investment in the health sector is crucial to avoid the deterioration of health and wellness centres, similar to the current condition of primary health centres and sub-centres.
What are the Obstacles to Achieving Universal Healthcare in India?
- Unequal Access to Health Insurance:
There is an imbalance in health insurance coverage, with the lowest percentage of coverage being among households with the lowest wealth quintile and disadvantaged groups, indicating a lack of fair access to health insurance. According to the latest National Family Health Survey (NFHS), only 36.1% of households in the lowest wealth quintile have insurance coverage.
Inadequate Financial Protection:
Despite initiatives like Janani Shishu Suraksha Karyakram, the average out-of-pocket expense for deliveries in public health facilities remains high, especially in urban areas. There are significant differences in out-of-pocket expenses and access to healthcare across different states in India, with many northeastern and larger states experiencing an increase in out-of-pocket expenses from the previous survey (NFHS-4) to the latest (NFHS-5). The average out-of-pocket expense per delivery in a public health facility, according to the NFHS, is Rs. 2,916, with Rs. 3,385 for urban areas and Rs. 2,770 for rural areas.
- Errors in Health Insurance Policies:
Recent research has shown that, like previous health insurance policies, the Pradhan Mantri Jan Arogya Yojana (PMJAY) also suffers from inclusion and exclusion errors, which could result in the inclusion of ineligible households and the exclusion of eligible ones.
- Availability of Services:
Although 56% of hospitals under the PMJAY are public, 40% are private for-profit, indicating that access to services may be limited to regions where publicly funded health insurance schemes have been implemented previously.
- Inadequate Infrastructure:
In many low- and middle-income countries, inadequate infrastructure, including insufficient healthcare facilities, equipment, and medical supplies, poses a significant obstacle to achieving universal healthcare. There is a shortage of 79.5% of specialists at Community Health Centers (CHCs) compared to requirements.
Poor Health Education:
A lack of education and awareness regarding healthy lifestyles and preventative health measures can lead to a rise in preventable diseases and conditions.
Strategies for Achieving Universal Healthcare
- Addressing the Challenges and the Way Forward
To achieve universal healthcare in India, several challenges must be addressed, and various strategies must be implemented. One of the key challenges is the inequitable access to health insurance. The lowest coverage of health insurance is among households with the lowest wealth quintile and underprivileged sections, indicating a lack of equitable access to health insurance. In addition, despite the existence of schemes like Janani Shishu Suraksha Karyakram, the average out-of-pocket expenditure per delivery in public health facilities is still high, particularly in urban areas.
- Enhancing health expenditure
To address these challenges, enhancing health expenditure as a percentage of GDP is crucial. India currently spends only 3.2% of its GDP on health, which is much lower than the average health spending share of the GDP of the Lower and Middle Income Countries. Strengthening the primary healthcare sector is another area of development that needs special attention. The government should increase its spending on healthcare and allocate more resources to build a strong healthcare infrastructure.
- Expanding health insurance coverage
Expanding health insurance coverage to all citizens is another crucial strategy. This would help reduce out-of-pocket expenses and make healthcare more affordable. Strengthening primary healthcare is crucial for achieving UHC. This includes increasing access to primary healthcare facilities, improving the quality of care, and strengthening the primary healthcare workforce. Quality of care is also important, and the government should invest in improving the quality of care by developing quality standards, ensuring adherence to these standards, and providing training to healthcare providers.
- Investing in preventive healthcare
Investing in preventive healthcare can help reduce the burden of disease and the cost of healthcare. The government should promote preventive healthcare measures, such as vaccination programs, health education campaigns, and lifestyle interventions. Finally, achieving UHC requires a collaborative effort between the government, healthcare providers, and civil society. The government should foster partnerships with healthcare providers and civil society organizations to achieve UHC.