Reversing Health Sector Neglect With A Reform Agenda

Context: The lack of effective Universal Health Coverage (UHC) makes a health-care reform in India post COVID-19 indispensable.

Issues holding back Healthcare Reforms:

• United States: Fragmented private insurance landscape and love for expensive specialized care limiting the expansion of health measures and improving access.

• E.g. The US A?ordable Care Act (ACA) failed to alter the insurance landscape.

• India: Maldistribution of healthcare facilities and low budgetary appropriations for insurance could not help translate into UHC 

• Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB­PM­JAY): a tool for achieving UHC heavily relies on the private sector.
• Absence of regulatory robustness: in handling malpractices and monopolistic tendencies, has a major cost, equity, and quality implications.

• For, E.g. a potent ‘Clinical Establishments Act’ is a must before embarking on a UHC involving large­scale public­private collaboration.
• National Digital Health Mission (NDHM): it will add administrative complexity and costs in the absence of regulations, robust ground-level documentation practices and its prerequisites.

• Political Hindrances: Integrating fragmented schemes into a unified system, is challenged by sustained political consensus.

• Path-dependent Trajectory of Long Legacy: resists the changes brought in through reforms.

• In the United States: The ACA reforms superimposed on non­negotiable elements, constrained the nature and scope of those reforms.

• E.g. the ACA has been not very successful in ensuring access commensurate with insurance levels and checking the rise of premiums and out­of­pocket costs.

• In India: The bigger and deeper the reform, the more is the resistance.

• Turning the AB-PM-JAY into a contributory scheme based on premium collection would be a costly and daunting task, given the huge informal sector.
• Harmonizing the benefits ad entitlements among the beneficiary groups and formalization of outpatient care remains a formidable challenge.

Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY):

• AB-PM-JAY is envisaged as a tool for achieving Universal Health Care (UHC).
• It currently covers the bottom 40% of the population
• It may extend coverage to the non-poor population

Way forward:

• Robust regulatory and administrative architecture for the effective roll-out of UHC 

• Mobilize sufficient and sustained political consensus for integrating fragmented schemes into a unified system

• Widespread public consensus and pressure for health-care reform by civil society 

• Invoking States with higher per-capita public spending on health to back the reform as they fared better against COVID-19.

• Politics need to encourage health: having populist significance and marshal enough will to negotiate organized opposition to change.