The article highlights the issues with India’s approach in achieving universal health care and issues with it.

Learning from the experience of Thailand

• About 20 years ago, Thailand rolled out universal health coverage at a per capita GDP similar to today’s India.
• What made this possible was a three decade-long tradition of investing gradually but steadily in public health infrastructure and manpower.
• This meant that alongside the availability of funds, there also existed robust institutional capacity to assimilate those funds.
• This is important because enough evidence exists on weak fund-absorbing capacities particularly in the backward States in India.

Budgetary allocations for health

• The Union Ministry of Health and Family Welfare budget for 2021-22, viz. ₹73,932 crore, saw a 10.2% increase over the Budget estimate (BE) of 2020-21.
• Also, a corpus of ₹64,180 crore over six years has been set aside under the PM Atma Nirbhar Swasth Bharat Yojana, (PMANSBY).
• ₹13,192 crore has been allocated as a Finance Commission grant.
• These allocations could make the first steps towards sustainable universal health coverage through incremental strengthening of grass-root-level institutions and processes.

Two important and prominent arms of universal health coverage in India merit discussion here

1) Insurance route for achieving universal health coverage and issues with it

• The Pradhan Mantri Jan Arogya Yojana (PM-JAY) has stagnated at ₹6,400 crores for the current and a preceding couple of years.
• Large expenditure projections and time constraints involved in the input-based strengthening of public health care have inspired the shift to the insurance route.
• However, insurance does not provide a magic formula for expanding health care with low levels of public spending.
• Beyond low allocations, poor budget reliability merits attention.
• Another related issue is the persistent and large discrepancies between official coverage figures and survey figures (for e.g. the National Sample Surveys, or NSS, and National Family Health Survey) across Indian States.
• Such discrepancies indicate that official public health insurance coverage fails to translate into actual coverage on the ground.
• Robust research into the implementational issues responsible for such discrepancies and addressing them is warranted.
• Without the same, the PM-JAY’s quest for universal health coverage is likely to be precarious.
• Finally, even high actual coverage should not be equated with effective financial protection.
• For example, Andhra Pradesh has among the highest public health insurance coverage scores (71.36%, NSS 75), but still has an out-of-pocket spending share much above the national average.

2) Comprehensive primary care

• Health and Wellness Centres — 1,50,202 of them — offering a comprehensive range of primary health-care services are to be operationalised until December 2022.
• Of these, 1,19,628 would be upgraded sub health centres and the remaining would be primary health centres and urban primary health centres.
• Initially, most States prioritised primary health centres/urban primary health centres for upgradation over sub health centres, since the former required fewer additional investments.
• Till February 2, 58,155 health and wellness centres were operational, of which 34,733 were sub health centres and 23,422 were primary health centres/urban primary health centres.
• This means that of the remaining 92,047 health and wellness centres to be operationalised by December 2022, 84,895 will be sub health centres.
• This offers huge cost projections.
• The current allocation of ₹1,900 crore, an increase of ₹300 crore from previous year, is a paltry sum in comparison.
• Since 2018-19, when the health and wellness centre initiative began, allocations have not kept pace with the rising targets each year.
• Additional funding under the PMANSBY and Finance Commission grants is reassuring, but a greater focus on rural health and wellness centres would be warranted.
• Two untoward implications could result from under-investing and spreading funds too thinly.
• Continuing the expansion of health and wellness centres without enough funding would mean that the full range of promised services will not be available, thus rendering the mission to be more of a re-branding exercise.
• Second, under-funding would waste an opportunity for the health and wellness centre initiative to at least partially redress the traditional rural-urban dichotomy by bolstering curative primary care in rural areas.

Consider the question “What are the challenges in adopting the insurance model in achieving the universal health coverage in India?” 

Conclusion

COVID-19 has prodded us to make a somewhat stout beginning in terms of investing in health. The key, and the most difficult part, would be to keep the momentum going unswervingly.

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