Health care expenditure has often been cited as one of the top three reasons for the population sinking into poverty even while a vast majority of citizens either struggle or fail to access quality care.
This report aims to rationalize and recommend financing needs and potential incentives to generate funds to facilitate a successful and sustainable Universal Health Coverage (UHC) program for India.
The report also attempts to define the context of possible health care demand, role of the government and private sector, financing imperatives and critical success factors for establishing a sustainable UHC.
What is UHC?
UHC is an evolved form of health franchise where the government guarantees equitable access to key promotive, preventive, curative and rehabilitative health interventions at affordable costs for all its citizens. In 2005, the World Health Assembly urged its member states to work toward UHC after considering the particular macroeconomic, socio-cultural and political context of each country.
Case for UHC for India
- Cost of treatment largely unaffordable: Almost 80% of urban households and 90% of rural households are estimated to find average cost of in-patient treatment to be almost half of their annual household expenditure, indicating a high degree of financial hardship. It is estimated that 3% of India’s population slips below poverty line each year because of health-related expenses.
- Utilization of health care services depends on affordability: According to the NSSO’s 66th round survey of household expenditure on various goods and services, between the bottom-most decile and the highest decile of Monthly Per Capita Expenditure (MPCE) classes, the number of people reporting the use of in-patient care in urban and rural areas increases by 2 and 3.5 times, respectively.
- Significant population remains untreated: Nearly 12%–15% of reported ailments are estimated to remain untreated due to the cost of treatment being unaffordable. This number could be much higher in real time, as sensitivity to ailments is a function of the ability to avail health care.
- Inequitable distribution of infrastructure: Though rural India bears three-fourths of the ailment burden, it has only one-ninth of the total number of beds and one-fourth of the number of human resource for health. Previously, the economic challenges of being a subsistence economy may not have been conducive to adopt UHC as a policy imperative. However, with India now well on the path of economic resurgence, the time has come to actually turn UHC into reality.
Although the economic benefits of UHC may not be quantifiable, the benefits are likely to be substantial in terms of impact on GDP through increased productivity from a healthy population and the creation of employment opportunities in the health care sector.
Relevance of global experiences
International experience strongly suggests that there is no unified approach to delivering a successful UHC program. All countries need to make tradeoffs, particularly in the way pooled funds will be raised and utilized. Priorities need to be constantly revised in terms of whom and how resources will be raised from, whom and for what will the resources be utilized and the proportion of total health care costs.
Health care spend as a percentage of GDP across most nations that have achieved more than 80% coverage of population through universal health systems is 5%–12%, with exceptions such as Thailand (3.9% of GDP) and the Philippines (3.6% of GDP). To assume appropriateness of these reference points as benchmarks and take them as representatives of the typical cost burden of UHC may not be correct in the Indian scenario.
On the contrary, the efficiency of health care systems, and policies and practices adopted by nations (which in the case of India are unique and may not be comparable with other countries) define costs of health care delivered and, consequently, the extent of GDP spends on health care.
In India, the lower affordability of average citizens has led to the creation of systems and policies that are capable of delivering health care at low costs. We need to be acutely sensitive of preserving them while creating a UHC system that is sustainable at a reasonable level of spend while ensuring outcomes that are comparable globally.