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HOPS As A Route To Universal Health Care


Healthcare as an optional public service will ensure the legal right to receive free, quality care in a public institution


GS-II: Government Policies and Interventions for Development in various sectors and Issues arising out of their Design and Implementation.

Dimensions of the Article

  • Healthcare vis-à-vis Universal Health Coverage
  • Routes to Universal Health Coverage
  • Challenges to Universal Health Coverage
  • Right to Health Care
  • Issues with HOPS
  • Tamil Nadu: A Case Study
  • Way Forward

Healthcare vis-à-vis Universal Health Coverage (UHC)

  • UHC has become a well-accepted objective of public policy around the world.
  • Equally effective in Developed and Developing Countries
  • Time for India or at least some states to consider implementing UHC.
  • Basic idea of UHC is that anyone should not be deprived of quality healthcare because of inability to pay.
  • Aneurin Bevan, Founder of National Health Services (NHS-UK) said that –  “No society can legitimately call itself a civilized if a sick person is denied medical aid because of lack of means.”
  • Idea of UHC inspired the Bhore Committee in 1946 which batted for NHS type health care system.

Routes to Universal Health Coverage

  • Two approaches – Public Service and Social Insurance
  • Public Service – Healthcare is provided as a free public aid.
  • Social Insurance – Allows public as well as private provisions of healthcare but the service is paid for by the Social Insurance Funds and not the patient.
  • Basic principles have been same for all the variants of the UHC – everyone should be covered and insurance should be geared to public interest and not profit making.

Challenges to Universal Health Coverage

  • Absence of Public Health Centres can lead to patients rushing to expensive healthcare options.
  • Containing costs will be a tough as both patient and the insurance provider have a joint interest in expensive care.
  • Co-Payments too can exclude many poor patients out of the quality healthcare net.
  • Regulating private healthcare providers is challenging as a distinction will need to be made between for-profit and non-profit entities.
  • A primary health centre can be productive only if doctors and nurses are on the job and care for patients.

Right to Health Care

  • An NHS will not be able to displace the private healthcare sector so soon.
  • However, a UHC can be envisaged that would build on primary health care as a public service and can later on converge to some sort of NHS.
  • This can be HOPS – Healthcare as an Optional Public Service.
  • Everyone would have legal right to receive free, quality healthcare in a public institution if they wish.
  • Anyone can avail services of the private sector if they wish but public sector would provide and guarantee decent health services as a matter of right.
  • HOPS would be a big step towards UHC though not as egalitarian as NHS.
  • Social Insurance can play limited role in this system to help cover procedures which are not easily available in public sector.
  • Social Insurance can be made to work mainly with non-profit agendas to avoid the risk of healthcare being tilted to tertiary and expensive care.

Issues with HOPS

  • Specifying the scope of HOPS as UHC can’t be unlimited.
  • Determining the quality standards of healthcare service.
  • Disparity among states in implementing HOPS.

Tamil Nadu: A Case Study

  • Tamil Nadu is well placed in terms of making HOPS into reality wit its Right to Health Bill.
  • TN already provides most healthcare services in the public sector with good effect.
  • Right to Health will be a strong affirmation of the State’s commitment to quality healthcare.
  • It would empower the patients and public in general thereby improving the system.

Way Forward

Healthcare is a basic necessity for all. India needs to focus on improving its healthcare in a holistic manner. States like Tamil Nadu and Kerela can mark the beginning of a transformed healthcare sector in India be serving as an inspiration to other states.

Source – The Hindu

July 2024