Background

  • Recognizing the importance of health, UHC has become a well-accepted objective of public policy not just in developed countries but also in developing countries. Even countries with relatively low per capita GDP have decisively moved towards universal health care (UHC).

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Universal Health Care

  • Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. Thus the basic idea of UHC is that no one should be deprived of quality health care for the lack of ability to pay.
  • UHC includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

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Routes to UHC

  • Universal health cover typically relies on one or both of two basic approaches: public service and social insurance.
    • Under the public service model, health care is provided as a free public service through public health centres.
    • Under the social insurance as well as public health care, wherein the costs are borne by the social insurance fund(s) and not the patient. Social insurance is very different from a private insurance market in that it is mainly financed from general taxation and is also compulsory and universal and is run in the public interest rather than for private profit.

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Challenges

Public healthcare system:

  • The public healthcare system in India is characterized by a lack of good management and adequate resources both in terms of manpower as well as infrastructure.
  • Also, they continue to be plagued by poor work culture.

Social insurance:

  • Costs remain a major challenge with social insurance because patients and healthcare providers have a joint interest in expensive care.
  • Excessive reliance on social insurance often leads to the negligence of public health service. In the absence of public health centres, there is a danger of patients rushing to expensive hospitals every other day. This would make the system wasteful and expensive. Any move to avoid this by opting for a co-payment model (the patient is required to bear a part of the costs) could exclude many poor patients from quality health care.
  • Another challenge with social insurance is the excessive reliance on private healthcare providers whose primary motive remains profit. This necessitates their regulation.

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Recommendations

HOPS model:

  • Today, though most countries with UHC rely on a combination of public service and social insurance, the article argues that the public service model based on the public healthcare system might be the best way forward.
  • However, recognizing the limitations of the public health system in India the article proposes a “healthcare as an optional public service” (HOPS) model for the time being. Under this model, everyone would have a legal right to receive free, quality health care in a public institution if they wish, however, this would not prevent anyone from seeking health care from the private sector at their own expense.
  • ‘Healthcare as an optional public service’ would ensure the legal right to receive free, quality care in a public institution. This model is visible in states like Kerala and Tamil Nadu, where most illnesses can be satisfactorily treated in the public sector, at little cost to the patient. There is also a thriving private sector too for people who can afford the costs.
  • Though the HOPS model would not be able to meet the ideal of UHC, it would still be a big step towards UHC. Efforts should be taken to strengthen the public healthcare system.
  • Regarding social insurance, it could play a limited role in this framework, to help cover procedures that are not easily available in the public sector (e.g., high-end surgeries). Also, the social insurance model should be restricted to work mainly within the non-profit sectors (public and private), leaving out for-profit health care as far as possible.
  • The HOPS framework should be based on a healthcare guarantee, including quality standards.
  • Tamil Nadu’s proposed Right to Health Bill could act as a model.

Distinction between for-profit and non-profit private players:

  • A distinction needs to be made between for-profit and non-profit providers.
  • Private non-profit health care can be regarded as a form of public service, and private for-profit health care needs to be strictly regulated.

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