Universal health coverage is the best prescription 

Universal health coverage is the best prescription 

Context

UHC provides the framework in which the issues of access, quality and cost can be integrated

Major issues

Three major issues are involved when we assess health care:

• Access
• Quality
• Cost

Each of these needs to be addressed with clarity, and not in isolation

UHC

Solutions have to be those that fit into a common system architecture, or a system best designed and delivered as Universal Health Coverage (UHC), now enshrined in the Sustainable Development Goals

Problems

• Access to readily reachable, trustworthy and affordable health care is a major challenge before poorly served rural areas and overcrowded urban areas
• The inadequacy of organised primary health services
• Corporate hospitals are inaccessible to the rural population and the urban poor
• Government institutions of advanced care suffer from low budgets and a lack of managerial talent

Improving access

The pathway to improving access lies in expanding the network of public sector facilities at all levels

• This calls for higher levels of public financing, investment in training and incentivised placements of more health personnel and improved management through the creation of a public health management cadre
• Filling the gaps: Health-care providers in the private and voluntary sectors should be empanelled to fill the gaps through carefully crafted contracting mechanisms that best serve public interest
• Quality of care: There must be an emphasis on the benefit and safety of tests and treatment, and ensuring that satisfaction levels of patients, families, care providers in the nature of institutional processes as well as human interactions are met
  • This requires ensuring conformity to accepted scientific and ethical standards. Here, the Clinical Establishments Act is a good beginning, in moving health-care facilities towards registration, ensuring compliance with essential standards of equipment and performance, adopting standard management guidelines, grievance redress mechanisms, and respecting encoded patient rights

Managing cost

Cost of care is a major challenge in a system where patients and families have to bear the burden

Problems

• High out-of-pocket spending on health care leads to unacceptable levels of impoverishment
• Small risk pool: With high levels of poverty and a very large segment of the working population in the informal sector, both private insurance and employer provided insurance can cover only small population segments. With a small risk pool, these schemes can only provide limited cost coverage to subscribers
• Government schemes not much success: Government-funded social insurance schemes do increase access to advanced care. But they have not been shown to provide financial protection as they cover only part of the hospitalisation cost and none of the expenses of prolonged outpatient care which forms a higher percentage of out-of-pocket spending

Solution

The solution lies in

• Doubling the level of public financing to at least 2.5% of GDP by 2019, rather than 2025, as proposed in the National Health Policy
• Single payer system: By pooling tax funding, all Central and State insurance schemes and employer-provided health insurance into a “single payer system”. That can be managed by an empowered autonomous authority which purchases services from a strengthened public sector and, as necessary, from empanelled private health-care providers
• Promoting quality: Quality is promoted through audited insistence on implementation of standard management guidelines by all service providers who enter this system
• Controlling cost: Cost is controlled by the negotiating power of the single payer. Since the risk pool is very large, there is a high level of cross- subsidisation of the sick by the healthy, the poor by the rich and the elderly retired by the young employed. The burden on an individual is greatly minimised

Way ahead: Integrate UHC

• Implemented piecemeal, these three areas of action will yield only limited results as access alone cannot assure appropriate or affordable care and cost subsidy will be meaningless if there is limited access or undependable quality
• The UHC provides the framework in which all three elements can be integrated

SDG 3: Health

The United Nations Sustainable Development Goals that all UN Member States have agreed to try to achieve Universal Health Coverage by 2030. This includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all