The article analyses the issues India could face in implementing the universal health coverage.

Context

• Both India and the U.S. leads the Covid cases in the world and also lack effective universal health coverage (UHC).

What explains the lack of UHC in both the countries

• The lack of UHC is due to multiple long-standing factors and historical reasons that have put a damper on the UHC agenda.
• This long legacy has two important and inter-related implications when it comes to health-care reform.
• 1) Certain foundational aspects of these health systems that have been adopted over decades tend to dictate the terms of further evolution and lead to a number of compromises.
• 2) The long legacy itself comprises a path-dependent trajectory that precludes far-reaching health-care reform.
• This applies both to AB-PM-JAY and NDHM.

India’s attempt at UHC: Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana

• The government has looked poised to employ Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) health insurance as the tool for achieving UHC.
• Taking the health insurance route to UHC driven by private players, rather than strengthening the public provisioning of health care, is reflective of the non-negotiability of private health care in India.
• Covering the remaining population under the AB-PM-JAY presents massive fiscal and design challenges.
• Turning it into a contributory scheme based on premium collections would be a costly and daunting undertaking, given the huge informal sector and possible adverse selection problems.
• Distributing benefits among various beneficiary groups, and a formalisation and consolidation of practices in a likely situation of covering outpatient care, are formidable additional challenges.
• One possible advantage for India over the U.S. could be a relative ease of integrating fragmented schemes into a unified system. The AB-PM-JAY has this ability.

Issues with AB-PM-JAY

1) Universal insurance will not be universal access

• In India, almost two-third corporate hospital are located in cities.
• So, such maldistribution of health-care facilities and low budgetary appropriations for insurance could mean that universal insurance does not translate to universal access to services.
• So far, insurance-based incentives to drive private players into the rural countryside have been largely unsuccessful.

2) Lack of regulatory robustness

• AB-PM-JAY is without enough regulatory robustness to handle everything from malpractices to monopolistic tendencies.
• This could have major cost, equity, and quality implications.

National Digital Health Mission (NDHM)

• Integration and improved management of patient and health facility information are sought through NDHM.
• But in the absence of robust ground-level documentation practices and its prerequisites, it would do little more than helping some private players and adding to administrative complexity and costs.

Consider the question “What are the challenges India faces in the implementation of universal health coverage? Suggest the measures to achieve it.”

Conclusion

Upheavals offer a window for reforms. We cannot afford to be complacent and think that the pandemic will automatically change the Indian health-care landscape. It will require mobilising concerted action from all quarters.

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