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 Approach :

  • give a brief overview of India’s public health system.
  • Briefly mention the basic approaches to UHC.
  • Discuss HOPS with its possibilities and challenges.
  • Way forward.

Model Answer

India’s out-of-pocket expenditure stands at 62.6% of the total healthcare expenditure – one of the highest in the world. Also, according to OECD, India’s total healthcare spending (out of pocket + public) is 3.6% of GDP – much lower than many developing countries. India’s public healthcare spending is only at 1.4% of GDP. All these point to the dismal state of India’s public health system, that compromises with the affordability to access quality healthcare for all.

In this context, the concept of Universal Healthcare has gained currency, which is a much cherished public policy objective of both the central & state governments. The basic idea behind UHC is that no person should be deprived of quality healthcare for lack of paying abilities, since it contravenes the fundamental right to life.

The two basic approach to UHC are – (a) Public service & (b) Social insurance.

  • In the first approach healthcare is provided as a free public service (e.g. in Cuba, UK).
  • Second approach entails both public & private provision, wherein the costs are mostly borne by the Social Insurance Funds. Social insurance is a compulsory & universal insurance financed primarily from general taxation run either by a single non-profit agency (e.g. “national health insurance” in Australia & Taiwan) or by multiple non-profit agencies (e.g. Germany) in public interest.

There are challenges to social insurance – it works mainly within the non-profit sectors, as cost sharing is a major challenge. The healthcare providers are mostly profit-driven, while the patients desire better care. Thus, they both fuel expensive care, requiring the patient to bear part of the cost (“co-payment”), which goes against the principle of UHC. Even small co-payments exclude many poor patients from quality healthcare. Also, social insurance runs the risk of expensive tertiary care.

While most countries are relying on a combination of Public Service & Social Insurance, a framework for UHC can be built mainly on healthcare as public service. This is called – “Healthcare as Optional Public Service (HOPS)”.

It means that everyone will have the legal right to receive free, quality healthcare in a public institution if they so wish. It will not prevent anyone from seeking healthcare from private sector at their own expenses. But, the public sector will guarantee free of cost decent health services as a legal right to everyone. Some states like Kerala & Tamil Nadu are already trying this, where most illnesses are satisfactorily treated in public sector at little cost.

Few challenges & possibilities for HOPS :

  • although it is not egalitarian as NHS, but it is a big step towards UHC. Over time, it may become more egalitarian with the growing range of health services provided by the public sector.
  • Another difficulty is to specify the scope of the framework, including quality standards. HOPS require not only healthcare standards but also a credible method to revise these standards over time.

Tamil Nadu is well disposed to make HOPS a reality under its proposed Right to Health Bill, which is an affirmation of State’s commitment to quality healthcare for all. It will empower patients & their families to demand quality healthcare. It should act as a model for all Indian states to emulate. Also, there is a need to distinguish between for-profit & non-profit providers. If for-profit health care is allowed, it must have strict regulatory oversight

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