Universal Health Care has the Potential to Boost Economic Growth
The Universal Health Coverage (UHC) programme, adopted globally, aims to provide promotive, preventive, curative and rehabilitative services without any financial hardships. It ensures equal access to care regardless of income level, social status, gender, caste or religion, providing affordable and accountable health care to individuals and populations with the government being the guarantor and enabler, although not necessarily the only provider of healthcare services. In India, the concept of UHC was anticipated way back in 1946 by the landmark Bhore Committee report which envisaged a country where no individual will fail to access adequate care because of the inability to pay. Now UHC is one of the 17 Sustainable Development Goals (SDGs) adopted by the United Nations (UN) for eliminating poverty and building a more resilient planet. It’s also based on the World Health Organization (WHO) constitution of 1948 declaring health as a fundamental human right, as well as on the Health for All agenda set by the Alma-Ata declaration of 1978. UHC has the potential to boost economic growth, improve educational opportunities, reduce impoverishment and inequalities, and foster cohesion. Steps taken for achieving UHC will address public health challenges and vice versa.
In India, in October 2010, a high-level expert group (HLEG) on UHC was constituted by the Planning Commission with the mandate of developing a framework for providing easily accessible and affordable healthcare to all Indians. The critical area for the provision of UHC as per the recommendations were health financing, health infrastructure, health service norms, skilled human resource for health, access to medicines, vaccines and technology, management and institutional reforms, and community participation. Key recommendations pertaining to these areas were provided. The group had proposed that the government (central and state) should increase public expenditures on health. It also recommended ensuring availability of free essential medicines by increasing public spending on drug procurement and that user fees of all forms be dropped as a source of government revenue for health. Experts also put a lot of emphasis on primary health care as well as trained human resources. To improve community participation, it was recommended that Village Health Committees or Health and Sanitation Committees be transformed into participatory Health Councils. It also suggested strengthening the management systems of UHC systems, apart from recommending several institutional reforms.
However, the provision of UHC has not been free from challenges and India has one of the largest disease burdens in the world. We also have major problems related to malnutrition as well as reproductive and child health, gender inequality and availability of trained HR. Apart from this, inadequate funding, weak public health systems, weak management systems, inequalities in access to healthcare, unknown quality and health outcomes, commercialized, fragmented and unregulated healthcare delivery systems, and lack of integration between health and other sectors have added to the problems. There is also inadequate research to achieve healthcare for all as well as high out-of-pocket expenditure. Other factors like poverty, illiteracy, frequent and severe natural disasters have made matters complex.
Meanwhile, the Indian Government's expenditure on public health as part of the total health expenditure is about 30 per cent, which is the 17th lowest globally. We need adequate resources to empower healthcare services, reduce financial risks and barriers, and raise the capability of the population to effectively utilise available resources. There is enough evidence to show that strengthening of PHC is the most appropriate approach to achieve UHC. Hence, adopting an integrated national healthcare system built around a strong public primary care system would be the way forward.
Every year, over 63 million people face poverty due to healthcare costs alone, owing to the lack of financial protection of health-care needs. Consequently, out-of-pocket expenditure comprises 69 per cent of total health care costs in India. Less than a quarter of the Indian population has access to any mode of healthcare insurance. One of the key announcements made during the Union Budget 2018-19 was the Ayushman Bharat Program (ABP) scheme. It has two components -
a) Delivering comprehensive primary health care by establishing 150,000 health and wellness centres and,
b) providing financial protection for secondary and tertiary level hospitalization as part of the National Health Protection Scheme (NHPS). Additionally, the integration of Ayurveda and Yoga will further promote a holistic approach to the health of the community.
Simultaneously, there is also a need to pay close attention to the following areas: Nutrition and food security, water and sanitation, social inclusion to address concerns of gender, caste, religious and tribal minorities, decent housing, clean environment, employment and work security, occupational safety, and disaster management.
Although there have been numerous healthcare-related programs in India such as National Health Mission (NHM), Rashtriya Swasthya Bima Yojna (RSBY), Jann Suraksha Yojana (JSY) and several state-sponsored health insurance schemes, these are insufficient to provide and sustain UHC as they neglect primary care and outpatient care which are major contributors to out-of-pocket expenditure. Hence, the social objectives of these schemes would need to be merged and their scope considerably expanded to create a valued and viable model of UHC. Under financial protection, the plan will provide coverage of up to INR 500,000 a family a year for secondary and tertiary care hospitalization to almost 100 million low-income families (appx 500 million people). Thus, ABP will provide services for preventive, promotive, curative, diagnostic, rehabilitative and palliative care services. This program has also been referred to as ‘the world’s largest government-funded healthcare (insurance) program’.
