First Steps in the Journey to Universal Health Care

Context: COVID-19 has provided opportunities to take stapes to Universal Health Care.

Steps taken by the government so far: For achieving universal health coverage.

• • To Minstry of Health and Family Welfare: Rs73,932 crores, 10.2% increase over the last budget.
  • To PM Atma Nirbhar Swasth Bharat Yojana, (PMANSBY): A part from a budgetary allocation of Rs64,180 crores, Rs13,192 crores has been allocated as a Finance Commission grant.  
• Shift toward universal insurance: By introducing schemes like Pradhan Mantri Jan Arogya Yojana (PM-JAY). (Since input based strengthening of the primary health care requires large expenditure and time.)
• Focus on comprehensive primary health care: By upgrading Health and Wellness Centres (HWC) to sub-health centres, primary health centres and urban primary health centres.

Constraints in achieving universal health coverage

• Inefficiency of States in using funds: Unused funds in many backward states are more than half of the State’s public health expenditure.
• Related to insurance coverage :
  • Low allocation and poor budget reliability: Budget for the PM-JAY has stagnated at Rs6,400 crores for the current and a preceding couple of years.
  • Discrepancies in official coverage data:
    • Surveys like National Sample Surveys and National Family Health Survey indicates that the official coverage figures are exaggerated.
    • Even in states like Maharashtra, Gujarat, and Karnataka where state-level public health insurance schemes have been operational for around a decade also has this issue.
  • High coverage does not mean effective financial protection: e.g. 
    • Andhra Pradesh (AP) with public health insurance coverage scores of 71.36% has an out-of-pocket spending share much above the national average (72.2% of total health expenditure). 
    • Himachal Pradesh with public health insurance coverage of 3.87% has a lower out-of-pocket (46.4%). (having higher per capita public health spending (2 times that of AP))
• Implication of  Under Funding: in HWC: 
  • Underfunding will lead to lack of services in the HWCs and may not be able to redress the rural-urban dichotomy (by bolstering curative primary care in rural areas)

Way forward: For achieving Universal health care.

• Investing gradually and steadily in healthcare: E.g. Thailand rolled out universal health care based on three-decade long investment in public health infrastructure and manpower.
• Robust research into the implementational issues: responsible for such discrepancies in official data and addressing them is warranted.
• Focus on rural health and wellness centres: By providing adequate finances.