A joint study by the World Bank and the World Health Organisation (WHO): Tracking Universal Health Coverage: 2017 Global Monitoring Report, points out the abysmal state of health services across the globe. According to it, at least half of the world’s population does not have access to essential health services and for about 100 million people out-of-pocket health expenses are high enough to push them into extreme poverty each year.
The United Nations has envisaged Universal Health Coverage (UHC) as a possible solution to address this humongous problem. According to the WHO, Universal health coverage (UHC) means, “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship”. The underlying idea behind UHC is health for all at an affordable cost. The concept of Universal Health Coverage (UHC) emerged with the World Health Report of 2010 and considering its importance, the United Nation (UN) in 2015 included it as one of the Sustainable Development Goals. It has earmarked December 12 of every year as International Universal Health Coverage (UHC) Day.
Though the UHC movement has gained unprecedented momentum globally during the last five-six years, Japan, Singapore, and Thailand in Asia have been doing commendable work in this arena for many of the past decades. More than seventy countries across the world, with the notable exception of USA, have framed policies around the UHC. The common thread running across all such programmes is governmental involvement and action. India, the largest democracy of the world, too, has taken a vital step towards Universal Health Coverage (UHC). The Indian government rolled out a scheme- Ayushman Bharat: the National Health Protection Mission on September 25, 2018. This scheme has been framed after taking into consideration the dismal status of the health-care system in India, and also as a response to the order given by the Supreme Court of India to the Central Government to “do something” when the exorbitant prices of medical care were brought to its attention.
Ayushman Bharat is aimed at providing guaranteed access to free treatment to about 40% of India’s population. The population will be selected based on socio-economic factors. About 150,000 wellness clinics will be set up. They will provide comprehensive health care facilities such as free essential drugs, maternal and child health services, treatment for non-communicable diseases and much more. Setting up clinics is a tried and tested component of UHC that many countries like China and Sri Lanka have adopted to improve access to health services to the poor. And, theoretically, it should work in India.
In 1977, South Korea gave a strong push to compulsory health insurance and Japan designed national health insurance coverage as early as in 1961. To replicate their success, a second element of Ayushman Bharat is providing insurance cover to a fixed percentage of the population of the country against expensive in-patient hospital care. They are assured a sum of over 7000 USD (half a million INR) per year per family. Both these elements are integrated to form the base of the policy. The scheme aims to cover 100 million poor and vulnerable families, making it the world’s largest public health-care scheme.
The implementation of any UHC scheme requires huge financial resources. The financing issue is a matter of greater concern in countries like India with low public health care financing. The Indian Government’s public health spending is less than 1.5% of its GDP while the global average is six percent and even the World Health Organisation (WHO) recommends at least 5%. To bridge this huge gap in financing, some countries have devised innovative public finance schemes. The government spending on health care in the Philippines increased from 1.8% to 4.8% within a span of six years after the implementation of the Sin Tax Reform Law of 2012. Sin taxes collected on tobacco and alcohol were used to finance this increased spending. President Jokowi of Indonesia is financing expenditure on providing health care facilities to the poor through savings from cutting fuel subsidies besides increasing taxes on tobacco. In order to raise finance for the country’s public health system, the NITI Aayog, India’s government think-tank, in its Vision Document has proposed raising taxes on tobacco, alcohol and unhealthy foods such as sweetened beverages. The Indian Government has also committed to raising its public health spending to 2.5 percent of GDP by 2025. But that is hardly enough.
Another factor that is important for the success of UHC is cooperation among nations. To take an example, India and Japan have signed an agreement in October to hone the surgery skills of Indian doctors in the treatment of trauma. Countries can enter into arrangements similar to the International Health Partnership (IHP) entered into by the European Union countries to promote Health Systems Strengthening (HSS) and effective development of cooperation in the field of health.
Without a serious look at and resolution of all the related policy issues, UHC could also pass off as mere rhetoric. India has made some progress with Ayushman Bharat, but there are still issues with the policy and major challenges ahead. India’s PM Modi faces elections this year and his underperformance vis-a-vis UHC in India will cost him both policy-wise and politics-wise.
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