The goal of Universal Health Coverage (UHC), which aims to guarantee that all people and communities receive the health care they require without experiencing financial hardship, has become a global priority. This study compares India’s approach with other nations to see whether universal health care can be implemented. It explores the difficulties and possibilities involved in this kind of project, concentrating on the function of insurers and the possible advantages for the people of India.
India is at a turning point in its efforts to achieve universal health coverage (UHC), given the country’s diverse population and intricate healthcare system. To better understand the concept of UHC and its possible applications in India.
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What Is Universal Health Coverage?
According to WHO (World Health Organization), Universal health coverage means that everyone has access to the complete range of high-quality healthcare services they require, at the appropriate time and location, and without facing financial hardship. It includes all aspects of the essential health services including prevention, rehabilitation, treatment, and health promotion. To deliver this promise countries should have an efficient health system.
Primary Health Care (PHC) is one of the most effective and yet economical options for universal coverage. Each nation must choose its route to achieve universal health coverage (UHC), considering the requirements of its people and available resources.
Comparing UHC Models In Other Countries
Developed Nations
The United Kingdom’s National Health Service (NHS) is among the world’s oldest and most extensive publicly funded healthcare systems. The NHS was founded in 1948 and offers free healthcare services at the point of need to all UK citizens. It includes a broad range of services, such as hospital treatment, mental health services, primary care, and public health campaigns.
A common example of UHC in action is the healthcare system in Canada. Every province and territory in the nation is in charge of managing and providing healthcare services, and the system is primarily funded and run by the government. As per the Canada Health Act of 1984, all citizens and permanent residents of Canada are eligible to access free hospital and physician treatments at the point of care when they are medically essential.
Developing Nations
Thailand introduced the Universal Health Scheme (UHS) in 2002 which was a significant step not only in South and Southeast Asia but the entire world. It makes comprehensive healthcare accessible to all, for little cost at the point of delivery. This covers in-patient and out-patient care, primary and secondary, and even includes high-cost specialized treatments like cancer therapy and areas that are frequently underfunded such as rehabilitation and palliative care.
To address financial restraints and service coverage limitations, African nations including Rwanda, Kenya, and Nigeria have identified solutions including reprioritizing health spending, boosting service quality, and guaranteeing healthcare worker availability. Furthermore, creative strategies have been successful in providing non-UHC populations with accessible, long-lasting primary healthcare services. One such example is the Portable Health Clinic (PHC) in Bangladesh, which makes use of digital healthcare delivery systems.
These illustrations show how various developed and developing nations have adopted UHC models that are customized for their unique environments, but they all aim to guarantee that their citizens have affordable access to necessary healthcare services.
India’s Path to UHC (Ayushman Bharat)
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) was launched on 23rd September 2018, as a step towards Universal Health Coverage (UHC). This scheme aims:-
- To provide health insurance coverage of ₹5 lakh per family per year to around 50 crore (500 million) beneficiaries, focusing on the low-income population. (Pradhan Mantri Jan Arogya Yojana)
- To transform 1.5 lakh sub-centers and primary health centers into Health and Wellness Centres to provide affordable and quality primary care to the last mile. (Ayushman Bharat-Health and Wellness Centres)
Challenges to Implementing UHC in India
- India spends a considerably lower percentage of its GDP on public health compared to developed nations with UHC. Scaling up public funding to cover a larger population is a major hurdle.
- A large portion of India’s workforce is employed in the informal sector, making it difficult to collect regular health insurance contributions. Devising an inclusive financing mechanism for this segment is crucial.
- Physicians, nurses, and other healthcare workers are in low supply in India, particularly in rural regions. Disparities in access to healthcare services are made worse by the unequal distribution of healthcare personnel. To overcome this obstacle, we must increase the number of qualified healthcare workers and provide incentives for them to work in underprivileged areas.
- India frequently lacks a sufficient healthcare infrastructure, especially in rural and isolated regions. Many areas lack enough clinics, hospitals, medical equipment, and qualified medical personnel. To guarantee that all residents have access to basic healthcare services, addressing this issue will need large expenditures in the healthcare infrastructure.
- Despite government schemes, out-of-pocket expenses for healthcare remain high in India. Controlling these costs is essential to ensure UHC’s financial sustainability.
- The population of India is diverse, consisting of individuals from a range of cultural origins, speaking a variety of languages, and living in a variety of geographical locations. Disparities in health outcomes might result from geographical remoteness, linguistic difficulties, and cultural attitudes that impede access to healthcare treatments. These obstacles must be removed to implement UHC and guarantee that healthcare services are available and suitable for all demographic segments.
- Raising awareness about UHC schemes and encouraging people to utilize available services is essential. Community engagement and education programs can bridge this gap.
A comprehensive and multi-sectoral strategy including innovative finance mechanisms, government policies, workforce development and infrastructure expenditures in healthcare, and community participation is needed to address these difficulties. India can go closer to attaining Universal Health Coverage and making sure that all individuals have access to high-quality healthcare services without having to worry about their finances by addressing these challenges.
Opportunities for Insurers
PM-JAY Expansion
To administer PM-JAY, private insurers and the government may work together. Their proficiency in risk assessment, network administration, and claims processing can be quite helpful. Like Star Health and Allied Insurance leverages its existing hospital network to offer cashless treatment options for PM-JAY beneficiaries.
Insurance companies can be a major factor in providing health insurance to a larger population than PM-JAY currently serves. Expanding the market can involve providing customized programs for various income brackets.
By utilizing their technology expertise, insurers can expedite the adoption of PM-JAY. Creating user-friendly portals for processing claims and administering policies is part of this. For example, ICICI Lombard developed a mobile app for PM-JAY beneficiaries to access information and track claims.
Focus on Preventive Care
Health insurance plans that encourage routine checkups and vaccinations—preventive healthcare practices—can be created by insurers. Health insurance plans with benefits like free annual physicals and savings on screenings for preventive diseases are available from Niva Bupa. This is consistent with the government’s UHC-based emphasis on preventive healthcare.
Creating wellness initiatives that encourage healthy living can help policyholders and insurers alike by lowering healthcare expenses and the overall disease burden.
Insurance companies can identify people who are more likely to develop chronic illnesses and provide them with individualized preventive care plans by analyzing health data.
Designing Innovative Products
Micro-insurance plans can be designed by insurers for low-income populations specifically. For example, HDFC ERGO Health Insurance introduced ‘Arogya Sanjeevani,’ a micro-health insurance plan designed to serve the low-income population that PM-JAY does not cover. This plan provides reasonably priced hospitalization expense coverage.
Plans that target high-burden illnesses, such as cancer or heart disease, can offer precise coverage and financial security.
Access to healthcare services can be enhanced by providing insurance plans that include telehealth consultations, particularly in rural areas.
Partnerships
Public-private partnerships have the potential to enhance healthcare service delivery and infrastructure by utilizing the advantages of both sectors.
Policyholders may be eligible for cashless hospitalization and reduced treatment packages through partnerships with hospitals.
Benefits of UHC to People in India
Universal health coverage (UHC) in India has great potential for its people. They can receive high-quality healthcare without worrying about the cost thanks to UHC’s ability to protect them from the financial ruin brought on by medical bills. Greater financial stability leads to improved health results. The general population becomes healthier as early diagnosis and treatment become commonplace. Furthermore, UHC can provide people with the tools they need to better manage chronic conditions like diabetes and heart disease. People can take control of their health and well-being with the availability of regular check-ups, medication, and specialized consultations. In addition, UHC advances social justice by guaranteeing access to healthcare for all people, irrespective of their financial situation. By doing this, obstacles that keep people from getting essential medical care are removed. People who are empowered make their country healthier and more productive, which advances society as a whole.
In Conclusion
Despite numerous obstacles, India’s road to universal health coverage is not impossible. Achieving this challenging objective will require utilizing technical advancements, encouraging stakeholder participation, learning from effective models in other nations, removing systemic obstacles, and collaborating with stakeholders. India can create a better and more affluent future by adopting UHC and making sure that every individual receives the healthcare they require when they require it, without having to worry about paying for it.
