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UNIVERSAL HEALTH CARE
This document provides an overview of Universal Health Coverage (UHC) including: - Definitions and concepts of UHC. - A brief history of major UHC initiatives and policies around the world since the late 19th century. - Monitoring and evaluation of UHC through indices like the UHC Service Coverage Index. - India's initiatives toward UHC like the Ayushman Bharat program and various national health insurance schemes. - Key principles and focus areas outlined in India's 2011 High Level Expert Group report on UHC.
In this document
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Overview of Universal Health Coverage (UHC) seminar focusing on its definition, history, key concepts, and role of oral health.
UHC defined by WHO as access to necessary health services without financial hardship, emphasizing equity and quality.
Historical milestones from 1883 onwards highlighting global movements toward achieving UHC.
WHO partnerships and initiatives like UHC2030 aimed at improving global health coverage.
Need for 1 billion more people to access health services by 2030 as part of SDG target 3.8 with outlined monitoring indicators.
Details on measuring UHC service coverage index which assesses 16 essential health services.
Framework for monitoring primary health care performance with emphasis on rationale for UHC in light of COVID-19 disruptions.
Indian definition of UHC focusing on equity, comprehensive care, and patient rights as per High-Level Expert Group.
Focus areas in UHC like financing, human resources and recommendations for increasing health expenditure.
Ayushman Bharat initiative and various national health insurance schemes like RSBY providing health coverage.
Details on features of RSBY and other schemes focusing on coverage for economically weaker sections.
Overview of various Indian government-sponsored health insurance schemes targeting low-income and underserved populations.
Discussion on the need for increased health insurance coverage and introduction of low-cost insurance products.
Highlighting the importance of oral health in UHC and the impact of oral diseases on global health expenditure.
The vision for a National Digital Health Ecosystem supporting UHC including details of digital health standards.
Introduction of UMID card system aimed at enhancing healthcare delivery efficiency and scalability.
Summary and references for further reading on Universal Health Coverage, its principles, and impact.
Closing remarks by the presenter.
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UNIVERSAL HEALTH CARE
- 1. U N IV E R S A L H E A LT H C A R E Seminar no:12 1
- 2. • Introduction • History •Monitoring and evaluation of UHC • UHC service coverge index • High Level of Expert Group Report on UHC in India • Ayushman Bharat • National Health Insurance Scheme • Role of oral health in UHC • Role of national digital health mission on UHC • Universal health interface • Initiatives of UHC • Conclusion • References CONTENTS 2
- 3. Universal Health Coverageor UHC is defined as “ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services”. -(WHO, 2012) INTRODUCTION 3
- 4. CONCEPT OF UHC Equityin access to health services Quality of health services Financial-risk protection 4
- 5. 1883- Health InsuranceBill, Germany became the first country to make nationwide health insurance mandatory. 1933- Franklin D. Roosevelt, a Democrat, funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation 1948- In U. K. Enactment of the National Insurance Act in 1911 and the National Health Service (NHS) 1948- Article 25.1 of the Universal Declaration of Human Rights states right to health as an important fundamental right. 1949 -President Harry S Truman proposed universal health care 1965- Medicare and Medicaid was created by the proposal of Lyndon B. Johnson with Social Security Act; Proposals by Ted Kennedy, President Richard Nixon and Jimmy Carter that promoted variations of universal health care. HISTORY 5
- 6. 1966- The InternationalConvention on Economic, Social and Cultural Rights recognized "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 1978- Alma-Ata declaration & the vision of "health for all” 1993- An effort was made by President Bill Clinton and headed by first lady Hillary Clinton but was not enacted into law. 2005- World Health Assembly resolution 58.33 adopted 'Universal Health Coverage’ 2010- President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as “ObamaCare” was signed into law. 2011- High Level Expert Group Committee Report India 6
- 7. Role of WHO: •UHC is firmly based on the 1948 WHO Constitution. • WHO works with many different partners in different situations and for different purposes to advance UHC around the world. Some of WHO’s partnerships include: • UHC2030 • Alliance for Health Policy and Systems Research • P4H Social Health Protection Network • UHC Partnership • Primary Health-Care Performance Initiative 7
- 8. • To achieveSDG target 3.8 of Universal Health Coverage for all by 2030, at least 1 billion more people will need to have access to essential health services in each five-year period between 2015 and 2030. • The essence of UHC is universal access to people- centred health system with primary care as its foundation. • Community-based services, health promotion, disease prevention and immunization are key components. 2030 Agenda for SDGs 8
- 9. Target 3.8 -“Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. Two indicators to monitor target 3.8 within the SDG framework. • The proportion of a population that can access essential quality health services (SDG 3.8.1) • The proportion of the population that spends a large amount of household income on health (SDG 3.8.2). The UHC service coverage index combines 16 essential health services in 4 categories : UHC SERVICE COVERAGE INDEX (3.8) Reproductive, maternal, newborn and child health • family planning Infectious diseases • tuberculosis treatment Noncommunicable diseases • prevention and Service capacity and access • basic hospital access 9
- 10. Method of measurement •For each country, the most recent value for each tracer indicators is taken from WHO or other international agencies Preferred data sources: • Household surveys • Administrative data • Special facility surveys Expected frequency of data dissemination: • 2-3 years Expected frequency of data collection: • 1-5 years Limitations: • Due to data limitations, not all tracer indicators used to compute the index are direct measures of service coverage. These proxy indicators will be replaced in future years when more data become available. 10
- 11.
- 12.
- 13.
- 14. Monitoring and evaluationframework for PHC • This document responds to Member States’ request in resolution WHA on primary health care for guidance to assess, track and monitor PHC performance to accelerate progress towards UHC and the health-related SDGs . • The framework presented in this document are based on and support the 14 levers of the Operational framework for primary health care. • This document includes WHO’s Thirteenth General Programme of work, as well as other global health system monitoring efforts. 14
- 15. Strengthening health systemsbased on primary health care: accelerating progress towards UHC and health security 15
- 16. Before COVID-19 struck,the world was far short of reaching the Sustainable Goal (SDG) 3.8 targets and the goal of 1 billion more people benefiting from UHC by 2023. 16
- 17. Disruptions of essentialhealth services due to COVID-19 17
- 18. COVID-19 and financialprotection 18
- 19. • Report, adoptedthe following definition of Universal Health Coverage (UHC): Ensuring equitable access for all Indian citizens, resident in any part of the country, regardless of income level, social status, gender, caste or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative and rehabilitative) as well as public health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services. -HLEG • Constituted on October, 2010 19
- 20.
- 21. universality; equity; non-exclusion and non-discrimination; comprehensivecare that is rational and of good quality; financial protection; protection of patients’ rights that guarantee appropriateness of care, patient choice, portability and continuity of care; consolidated and strengthened public health provisioning; Principles of UHC in India 21
- 22. Health Financing andFinancial Protection Health Service Norms Human Resources for Health Community Participation and Citizen Engagement Access to Medicines, Vaccines and Technology Management and Institutional Reforms THE NEW ARCHITECTURE FOR UHC FOCUS AREAS Human resource requirements Access to health care services Management reforms Community participation Access to medicines Health care financing Social determinants of health Urban Health Female gender Public- private partnership Information technology- enabled Health services 22
- 23. Central government and statesshould increase public expenditures on health from the current level of 1.2% of GDP to at least 2.5% by the end of 12 th plan, and to at least 3% of GDP by 2022. 23
- 24.
- 25. Recommended agencies: 1. NationalHealth Regulatory and Development Authority (NHRDA) • The System Support Unit (SSU) • The National Health and Medical Facilities • Accreditation Unit (NHMFAU) • The Health System Evaluation Unit (HSEU) 2. National Drug Regulatory Authority (NDRDA) 3. National Health Promotion and Protection Trust (NHPPT) 25
- 26. Ayushman Bharat Ayushman Bharat,a flagship scheme of Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). Ayushman Bharat adopts two inter-related components, which are - • Health and Wellness Centers (HWCs) • Pradhan Mantri Jan Arogya Yojana (PM-JAY) 26
- 27. Arogya Karnataka HR Reforms DNB, Biddingof Specialists, filling positions - field level functionaries Financial Protection Scheme Harmonization Comprehensive Primary Health Care Health and Wellness Centres Free Diagnostics E-Hospital & Convergence of IT platform for continuity of care Free Drugs AROGYA KARNATAKA – UNIVERSAL HEALTH COVERAGE 27
- 28. • The Reportof the Primary Health Care Task Force, primary health care provides valuable insights into structure and processes that are required in health systems to enable Comprehensive Primary Health Care (CPHC). • The Twelfth Five Year Plan Identified Universal Health Coverage as a key goal and based on the recommendations of the High- Level Expert Group Report on UHC had called for 70% budgetary allocation to Primary Health Care in pursuit of UHC for India. 28
- 29. NATIONAL HEALTH INSURANCESCHEMES Rashtriya Swasthiya Bima Yojana (RSBY) Employment State Insurance Scheme (ESIS) Central Government Health Scheme (CGHS) Aam Aadmi Bima Yojana (AABY) Janashree Bima Yojana (JBY) Universal Health Insurance Scheme (UHIS) 29
- 30. 1.Rashtiya Swasthiya BimaYojana (RSBY) • To provide health insurance coverage for Below Poverty Line (BPL) families. • Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- for most of the diseases that require hospitalization. • The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of 23 million families have been enrolled as of February 2011. 30
- 31. Unique Features ofRSBY Empowering the beneficiary Business Model for all Stakeholders-Insurers, Hospitals, Intermediaries and Government Information Technology (IT) Intensive Safe and foolproof Portability Cash less and Paperless transactions 31
- 32. 2.Employment State InsuranceScheme (ESIS) • Employees’ State Insurance Scheme of India, is a multidimensional social security system tailored to provide socio-economic protection to worker population and their dependants covered under the scheme. • Applicability • The Act is applicable to non-seasonal factories employing 10 or more persons. • The Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatres, road-motor transport undertakings and newspaper establishments employing 20 or more persons. • The Scheme has been extended to Private Medical and Educational institutions employing 20 or more persons in certain States/UTs. • Areas covered • States :- All the States except Manipur, Sikkim, Arunachal Pradesh and Mizoram. • Union territories :- Delhi and Chandigarh 32
- 33. 3.Central Government HealthScheme (CGHS) • Provides comprehensive health care facilities for the Central Govt. employees and pensioners and their dependents residing in CGHS covered cities. Started in New Delhi in 1954. The medical facilities are provided through Wellness Centres /polyclinics under all systems of medicines. • The main components of the Scheme are: • The dispensary services including domiciliary care • F. W. & M.C.H. Services • Specialists consultation facilities both at dispensary, polyclinic and hospital level including X-Ray, ECG and Laboratory Examinations. • Hospitalization • Organization for the purchase, storage, distribution and supply of medicines and other requirements • Health Education to beneficiaries 33
- 34.
- 35. 4. Aam AadmiBima Yojana(AABY) • Aam admi bima yojana, a Social Security Scheme for rural landless household was launched on 2nd October, 2007. • A separate fund called "Aam Admi Bima Yojana Premium Fund" has been set up by Central Govt. to pay the Govt. contribution. Fund is maintained by LIC. 6.Universal Health Insurance Scheme (UHIS) • The four public sector general insurance companies have been implementing Universal Health Insurance Scheme for improving the access of health care to poor families. • The Universal Health Insurance Scheme (UHIS) has been redesigned targeting only the BPL families. • The Universal Health Insurance Scheme was launched on a countrywide basis in July 2003 with an objective to provide health care to poorest section of the society. 35
- 36. Government Sponsored SociallyOriented Insurance Schemes • Pradhan Mantri Jeevan Jyoti Bima Yojana(PMJJBY) • Pradhan Mantri Suraksha Bima Yojana(PMSBY) • Life Cover under Pradhan Mantri Jan Dhan Yojana (PMJDY) • Varishtha Pension Bima Yojana • Pradhan Mantri Fasal Bima Yojana(PMFBY) • Pradhan Mantri Vaya Vandana Yojana(PMVVY) • Restructured Weather Based Crop Insurance Scheme (RWBCIS) 36
- 37. Megha Health InsuranceScheme (MHIS) • The Megha Health Insurance Scheme (RSBY + UHIS) was launched on 15th December, 2012 by then Chief Minister Dr Mukul Sangma, in convergence with Rashtriya Swasthiya Bima Yojana (RSBY). • The objective to provide financial aid to all the citizens of the state at the time hospitalization and reduce the out-of-pocket expenses of the residents of the State (excluding state and central government employees) 37
- 38.
- 39. • A majorityof the world’s extreme poor people resided in low income countries, until India moved from the low income group to the lower-middle income group in 2007. • China and India, due to their population size and economic development, have had an enormous influence on global patterns of poverty and health aid. 39
- 40. Government Subsidized healthinsurance schemes: • India has multiple types of health insurance schemes. • They can broadly be bucketed into three categories based on financing source (Government tax revenue or contribution based), target group (e.g., formal sector workers), and compulsory versus voluntary nature of the scheme. • These schemes provide fully or partially subsidized insurance coverage to specific targeted segments of the population. • Social Health Insurance (SHI) Schemes • Private voluntary health insurance (PVHI) 40
- 41.
- 42. HEALTH INSURANCE /ASSURANCE IN INDIA: NEED AND LANDSCAPE • Low financial protection leads to high out-of-pocket expenditure (OOPE). • Pre-payment through health insurance emerges as an important tool for risk-pooling and safeguarding against catastrophic (and often impoverishing) health expenditure. • Pre-paid pooled funds can also improve the efficiency of healthcare provision. 42
- 43. RECOMMENDATIONS AND PATHWAYSTO INCREASING HEALTH INSURANCE COVERAGE 43
- 44. Aarogya Sanjeevani HealthInsurance Plan • The Insurance Regulatory Development Authority of India (IRDAI) launched a standardized health insurance product – Arogya Sanjeevani – in April 2020. • The sum insured is flexible – varying between Rs. 50,000 to Rs. 10 lakhs – based on the needs of the individual, or the family. Designing a low-cost comprehensive health insurance product for the missing middle: 44
- 45. Role of OralHealth in UHC • FDI welcomed the commitment to strengthen oral health in the United Nations (UN) Political Declaration on Universal Health Coverage (UHC), which was officially adopted by world leaders at the UN High-Level Meeting on UHC on September 23 in New York. • WHO’s 13th Global Programme of Work 2019–2023 with its focus on UHC can help move the global oral health agenda forward. • More than half of the world’s population (3.5 billion) suffer from untreated oral diseases, which can result in pain, infection, tooth loss and loss of productivity. • In 2010 direct treatment costs due to oral diseases worldwide were estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure FACTS 45
- 46. Vision To create aNational Digital Health Eco-system that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, through provision of a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems, and ensuring the security, confidentiality and privacy of health- related personal information. ROLE OF NATIONAL DIGITAL HEALTH MISSION ON UHC 46
- 47.
- 48. Universal health interfacebenefits: 48
- 49. Scope of NDHM Health and Well-being forALL; Health and Well-being at ALL Ages; Universal Health Coverage; Citizen- centric Services; Quality of Care; Accountabil ity for Performanc e; Efficiency and Effectivene ss in delivery of services; Creation of a holistic and comprehen sive health eco- system. Methods & Instruments recommended by NDHB • Federated Architecture • Universal Health Id (UHID) • Electronic Health Records (EHR) • Metadata & Data Standards (MDDS) • Health Informatics Standards • Registries for NCDs • Directories of Providers, Professionals and Para- medicals • Legislation and Regulations on Data Management, with focus on Privacy and Security • Data Analytics 49
- 50.
- 51.
- 52. UMID Card byIndian Railways Features of the UMID cards : • Electronic Platform • Card Free System • Change of Health Units • Automatic Generation of OPD Slips • Hospital-wise Debits and Credits • Hassle-free Usage • Both Web and Mobile Application • Applicability and Scalability • Continuous Validation Mechanism • CSTE Scheme Hospitals 52
- 53.
- 54. • Universal HealthServices, Inc. (UHS) is one of the largest and most respected providers of hospital and healthcare services in the US dedicated to improving people’s lives and transforming the delivery of healthcare. • Through its subsidiaries, the company operates 28 Acute Care hospitals, 335 Behavioral Health inpatient facilities, and 40 outpatient facilities and ambulatory care centers in 39 states in the U.S., Washington, D.C., Puerto Rico and the United Kingdom. 54
- 55. Physicians for aNational Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. 55
- 56.
- 57. REFERENCES https://www.who.int/health-topics/universal-health-coverage#tab=tab_1 https://www.who.int/publications/i?healthtopics=6b21a1ad-3bdd-44ba-a311-4abafa4efef3 https://www.niti.gov.in/long-road-universal-health- coverage#:~:text=India%20is%20committed%20to%20achieving,per%20cent%20of%20the%20population. https://www.nhp.gov.in/universal-health-coverage_pg https://uiic.co.in/en/taxonomy/term/1283 https://www.etrainstatus.com/railnews/umid-card-by-indian-railways/ https://www.who.int/news-room/fact- sheets/detail/universal-health-coverage-(uhc) https://www.commonwealthfund.org/international-health-policy-center/countries/india https://gh.bmj.com/content/5/9/e003801 https://www.bankbazaar.com/health-insurance/universal-health-insurance-scheme.html https://journals.sagepub.com/doi/abs/10.1177/0971721820912920?journalCode=stsa https://www.nhp.gov.in/national-health-insurance-schemes_pg 57
- 58. https://nha.gov.in/PM-JAY https://financialservices.gov.in/insurance-divisions/Government-Sponsored-Socially-Oriented-Insurance- Schemes/Pradhan-Mantri-Suraksha-Bima-Yojana(PMSBY) https://iphindia.org/implementation-indias-national-health-insurance-scheme-experience-field/ https://www.healthindiatpa.com/rsby/index.aspx https://www.uhs.com/ https://pnhp.org/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541093/ https://mhis.org.in/ https://www.researchgate.net/publication/274313651_Universal_Health_Coverage_for_Inclusive_and_Sustain able_Development_A_Synthesis_of_11_Country_Case_Studies https://www.ncbi.nlm.nih.gov/books/NBK373408/ https://in.one.un.org/task-teams/universal-health-coverage/ 58
- 59.
Editor's Notes
- #5 This definition of UC embodies three related objectives: The three dimensions to be considered for moving towards UHC are: Equity to health services: For those who need the services should be able to get them and not just one who can pay for them. The quality of health services: The services is good enough to improve health of those receiving the services Financial Risk protection: Ensuring that cost of using care does not put people at risk of financial hardship.
- #14 Objectives to support Member States to assess, track and monitor PHC performance improvement across the three components of PHC and 14 core strategic and operational levers within the context of national and subnational policy and planning processes; to align PHC monitoring within existing health system, UHC and SDG monitoring frameworks and guidance in order to maximize and advance internationally comparable PHC performance monitoring and improvement efforts, fill data gaps, and minimize reporting burdens; to enable global tracking of the progress of WHO Member States in strengthening PHC towards the achievement of UHC by 2030 through the provision and alignment of a global set of indicators that can assist in cross-country review of aggregated data.
- #15 This document responds to Member States’ request in resolution WHA 72.2 on primary health care for guidance to assess, track and monitor PHC performance to accelerate progress towards UHC and the health-related SDGs . The framework presented in this document are based on and support the 14 levers of the Operational framework for primary health care. This document aligns with and advances WHO’s work in monitoring UHC and the SDGs, including WHO’s Thirteenth General Programme of work, as well as other global health system monitoring efforts, thus minimizing the country-level reporting burden and reducing the risk of duplication. The result of this alignment and extensive consultation is a menu of indicators that countries can use and prioritize based on national context and h
- #18 Accelerating progress towards UHC SDG 3.8 targets in the COVID-19 pandemic era
- #19 Service disruption is not the only barrier to seeking care during the pandemic, with the World Bank high-frequency survey showing that almost 19% of households sampled across 39 low- and middle-income countries reported not being able to access the health care services they needed. Of the access barriers referenced, financial constraints were the most commonly reported, though at a higher proportion for households in low-income countries compared to middle-income countries (71) (Figure 4.9).
- #20 Supported by the public health foundation of india Evolution of report was in 3 phases
- #22 Ten principles have guided the formulation of our recommendations for introducing a system of UHC in India:
- #26 We recommend the establishment of the following agencies:
- #28 Started in 2015-16 for Piloting Universal Health Coverage in Mysore a Non High Priority District Raichur a High Priority District
- #34 Maternal Child Health and Family Welfare)
- #35 mukhyaantri Beneficiaries of the scheme get cash less treatment in the government and private health institutions empanelled under the RSBY and MSBY as per their choice within the state and country. Additionally, transport expenses of ~ 2 US$ per hospitalization is paid to the beneficiary subject to a maximum of ~ 17 US$ per year per family. The beneficiaries need to pay only 0.5 US$ as registration fee for a year while the Central and State Government pays the fixed premium (12.5 US$) as per their sharing ratio (between Centre and State, 75:25 for RSBY, 0:100 for MSBY) to the private insurer selected by the state government on the basis of a competitive bidding [Fig. 1]. In India, 93% of workforce is in informal sector [18] where there is no formal employee and employer relationship arrangements, having both poor and non-poor [Fig. 1]. RSBY scheme for social security for the poor receives complete subsidy from the central and state Government. However, in case of MSBY, 100% subsidy is provided by the State Government of Chhattisgarh for non-poor [Fig. 1].
- #38 Universal health insurance scheme (UHIS) in the State of Meghalaya provides health insurance to all persons that are residents of the State
- #40 Low income countries relied more heavily on external aid to fund spending on immunization. Lower-middle income countries varied widely on how immunization was funded. Nigeria and India were outliers among countries with data: over half their spending on immunization was funded by private sources.
- #42 At least 30% of the population, or 40 crore individuals – called the missing middle in this report – are devoid of any financial protection for health The existing health insurance schemes can potentially cover 70% of the population – nearly 95 crores individuals, though actual coverage is lower
- #43 CHE- catatstrophic health expenditure low financial protection leads to high out-of-pocket expenditure (OOPE). India’s population is vulnerable to catastrophic spending, and impoverishment from expensive trips to hospitals and other health facilities (Figure 2) They are vulnerable to impoverishment from expensive trips to the hospital and other health facilities. Analysis from Brookings India based on NSSO surveys shows that over 7% of India’s population is pushed into poverty every year due to healthcare costs (Figure 2). At the 10% threshold level, 24% of households incurred catastrophic health expenditure in 2014, up from 21% in 2004 (Figure 2). The catastrophic effect of healthcare spending is not limited to the poor – it impacts all segments of the population (Figure 3).
- #44 A combination of implementation pathways – starting with commercial insurers and progressing to leveraging Government risk-pooling schemes for voluntary insurance – phased in at different times, will ensure coverage for the missing middle population (Figure 10). This report recommends the following. Expansion of health insurance coverage is a vital step, and a pathway in India’s effort to achieve Universal Health Coverage (UHC). India’s health sector is characterized by low Government expenditure on health, high out-of-pocket expenditure (OOPE), and low financial protection for adverse health events. India’s Government spending on health at 1.5% of GDP is among the lowest in the world. The private sector is characterized by high OOPE, leading to low financial protection. Relatively low health insurance coverage, and costlier provision of health services in the private sector drive India’s high out-of-pocket expenditure (OOPE). Why expand health insurance in India? Health insurance is a mechanism of pooling the high level of OOPE in India to provide greater financial protection against health shocks, improve efficiency in the organization and delivery of healthcare for better health outcomes. Increased health insurance coverage will reduce catastrophic and impoverishing health expenditure by imposing a ceiling on the maximum health expenditure incurred by an individual or household.
- #45 DESIGNING A LOW-COST COMPREHENSIVE HEALTH INSURANCE PRODUCT FOR THE MISSING MIDDLE In the absence of a low-cost health insurance product, the missing middle remains uncovered despite the ability to pay nominal premiums. A comprehensive product designed for this segment – improving upon the existing Arogya Sanjeevani plan and offering out-patient cover – can expand health insurance coverage.
- #48 A unified but decentralised network based on a standard protocol for all types of health services
- #49 all stakeholders
- #50 Vision same as NDHM
- #51 The goal of UHC is to ensure the quality, accessibility and affordability of health services. However, shortfalls remain in ensuring access to all who need health services and in ensuring that they are delivered with the intended quality without causing financial hardship to the people accessing them. The Tanahashi framework published by WHO in 1978 provides a time-tested model for understanding health system performance gaps and how they prevent the intended coverage, quality and affordability of health services. This cascading model illustrates how health systems lose performance because of challenges at successive levels, each dependent on the previous level. Health system challenges – such as geographical inaccessibility, low demand for services, delayed provision of care, low adherence to clinical protocols and costs to individuals/patients – contribute to accumulated losses in health system performance. These shortfalls limit the ability to close the gaps in coverage, quality and affordability, and undermine the potential to achieve UHC. Figure 1 Layers of UHC achievement affected by health system performance This adapted Tanahashi model illustrates that each health system performance layer builds on the components below it but also falls short (dotted lines) of the optimal, desired level (Figure 1). Digital health interventions could contribute to efforts to address challenges that limit achievement of that health system goal.
- #53 Cashless treatment scheme in emergency UMID helps in providing a unique identity to every individual, which is further strengthened by the unique smart features of web-enabled QR code and biometric identity.
- #57 Expected outcomes of UHC