Need for Universal and Equitable Health Coverage

Syllabus: GS2/Health

Context

• Universal and equitable health coverage ensures that every individual, regardless of their socio-economic status, has gained momentum, but significant challenges remain in achieving equitable access for all.

Understanding Universal Health Coverage (UHC)

• According to the World Health Organization (WHO), Universal Health Coverage (UHC) ensures that all people receive the health services they need, including prevention, treatment, rehabilitation, and palliative care, without suffering financial hardship. 
• UHC is based on three core principles:
  • Equity in access: Everyone, regardless of economic status, should receive quality healthcare.
  • Quality of services: Healthcare services must be safe, effective, and responsive to people’s needs.
  • Financial protection: No one should be pushed into poverty due to medical expenses.
• Sustainable Development Goals (SDG-3) focuses on ensuring healthy lives and promoting well-being for all at all ages.
• The right to health is enshrined in various international agreements, including the Universal Declaration of Human Rights (1948).

Barriers to Achieving Universal Health Coverage

• Financial Constraints (High Out-of-Pocket Expenditure): According to a National Health Accounts Report (2017-18), nearly 55% of total healthcare expenditure in India is borne by individuals.
• Low Budgetary Allowance: Government health expenditure (GHE) as a percentage of GDP rose from 1.13% to 1.84% between 2014-15 and 2021-22.
• Resource Constraints: There is a notable shortage of financial, clinical, managerial, and infrastructural resources, particularly in low- and middle-income regions, hindering the effective delivery of healthcare services.
• Limited Health Insurance Coverage: A significant segment of the population, often referred to as the ‘missing middle’, lacks any form of health insurance, leaving them vulnerable to financial distress due to medical expenses.
• Diverse Health Systems Across States: For instance, states like Kerala and Tamil Nadu have relatively advanced healthcare systems, while states like Bihar and Uttar Pradesh lag behind in terms of healthcare expenditure and outcomes.
• Digital Transformation: Leveraging digital technologies is crucial for improving healthcare accessibility, efficiency, and quality, yet implementing such transformations poses its own set of challenges.
• Political and Policy Challenges: Healthcare policies often suffer from inefficiency, corruption, and lack of political will.

Key Initiatives Driving UHC in India

• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY): It is the world’s largest government-funded health insurance scheme.
  • It provides free secondary and tertiary care hospitalization for over 50 crore (500 million) economically vulnerable individuals. 
  • It covers a range of treatments with an annual coverage of ₹5 lakh per family.
• Health and Wellness Centres (HWCs): As part of Ayushman Bharat, India is strengthening primary healthcare through HWCs.
  • These centers offer free diagnostic services, essential medicines, and preventive care, reducing the burden on higher-level healthcare facilities.
• National Health Mission (NHM): It has two sub-missions — National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) — aiming to provide equitable, accessible, and affordable healthcare.
  • It focuses on maternal and child health, communicable diseases, and non-communicable diseases.
• Digital Health and Telemedicine: The National Digital Health Mission (NDHM) is creating a digital ecosystem for seamless healthcare services, including electronic health records and teleconsultation.
  • eSanjeevani, a telemedicine platform, has facilitated millions of remote doctor consultations.
• Strengthening Public Healthcare Infrastructure: New AIIMS institutes are being set up under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY).
  • Investments in district hospitals and primary health centers aim to improve service delivery in rural areas.

Strategies to Achieve Universal and Equitable Health Coverage

• Government Investment: Countries must allocate a higher percentage of GDP to healthcare.
  • WHO recommends at least 5% of GDP for public health funding and National Health Policy (2017) for 2.5% of GDP.
• Strengthening Primary Healthcare: The government needs to focus on expanding and modernizing Primary Health Centers (PHCs) and Community Health Centers (CHCs), ensuring that quality healthcare reaches every village and town.
• Affordable and Inclusive Insurance Schemes: Expanding public health insurance and reducing out-of-pocket expenses is crucial.
• Public-Private Partnerships: Collaborations between governments and private entities can improve healthcare reach and efficiency.
• Digital Healthcare Solutions: Telemedicine, mobile health apps, and AI-driven diagnostics can bridge the urban-rural healthcare divide.

Conclusion

• Universal and equitable health coverage in India is not just an ideal but a necessity for national progress.
• Strengthening the public healthcare system, improving financial protection, and integrating technology-driven solutions are crucial steps in achieving this goal.
• If India can successfully implement UHC, it will not only enhance the well-being of its people but also contribute to a more robust and inclusive economy.

Source: TH