UNIVERSAL HEALTH COVERAGE

INTRODUCTION

Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

The delivery of these services requires health and care workers with an optimal skills mix at all levels of the health system, who are equitably distributed, adequately supported with access to quality assured products, and enjoying decent work.

Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because the cost of needed services and treatments requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

Achieving UHC is one of the targets the nations of the world set when adopting the Sustainable Development Goals in 2015. If achieved by India it will result in good overall health in children and adults ultimately pulling them out of poverty, and will become the basis for long-term economic development.

CONSTITUTIONAL PROVISIONS

   The Constitution of India’s Directive Principles of State Policy (DPSP) in Part IV provide a basis for the Right to Health, which could be used to support universal health coverage (UHC). The DPSP includes articles that:

• Article 39 (e): Direct the state to protect the health of workers
• Article 42: Emphasize fair and humane working conditions and maternity benefits
• Article 47: Require the state to improve public health, raise nutrition levels, and improve standards of living
• Article 243G: Allow municipalities and panchayats to strengthen public health

ISSUES

Key challenges facing India’s healthcare system include:

• Population Growth & Healthcare Demand: The population has surged from 760 million in 1985 to an estimated 1.4 billion in 2024, straining existing healthcare resources.
• Government Healthcare Services: While central and state governments offer universal healthcare with free treatment and drugs at public hospitals, these facilities often face issues like understaffing and inadequate funding.
• Reliance on Private Sector: Many patients turn to private healthcare due to gaps in the public system.
• Shortage & Maldistribution of Healthcare Providers: There’s a national shortage of healthcare professionals, heavily concentrated in urban areas, leaving rural areas underserved.
• Healthcare-Induced Impoverishment: About 7% of India’s population faces financial ruin due to the high cost of healthcare, as reported in recent surveys.
• Low Healthcare Expenditure: India’s per capita healthcare spending is among the lowest globally, with the government covering only 32% of insurance costs, compared to 83.5% in the UK.
• High Out-of-Pocket Expenses: With 76% of Indians lacking health insurance, many face significant out-of-pocket expenses, contributing to financial distress and suicides among farmers.
• Rural-Urban Healthcare Disparity: Rural healthcare centers are often poorly staffed, with a severe shortage of doctors increasing by 200% over the past decade.

IMPLICATIONS

ADVANTAGES/MERITS/PROS/BENEFITS

• Broader Access: UHC ensures that everyone, regardless of income, can access necessary healthcare, improving overall health outcomes.
• Financial Protection: It reduces the risk of financial strain by lowering out-of-pocket expenses, making healthcare more affordable.
• Equity in Healthcare: UHC promotes fairness by offering equal access to services, diminishing health disparities.
• Enhanced Public Health: UHC supports better disease control and early treatment through widespread access to preventive and curative services.
• Economic Gains: A healthier population is more productive and incurs fewer healthcare costs, boosting economic growth and reducing societal financial burdens.
• Better Quality of Life: By ensuring necessary care, UHC improves the overall quality of life.
• Reduced Healthcare Inefficiencies: UHC streamlines service delivery, minimizing redundancies and making effective use of resources.
• Political and Social Stability: Providing accessible and affordable healthcare fosters trust and stability within the community.

DISADVANTAGES/DEMERITS/CONS/DRAWBACK

• High Costs: Implementing UHC requires substantial government expenditure and potentially higher taxes.
• Resource Strain: Increased demand for services may strain existing resources like hospitals and medical staff.
• Potential for Longer Wait Times: The rise in demand could lead to longer wait times for non-emergency treatments.
• Quality Concerns: There may be a shift towards basic care to manage costs, possibly impacting the quality of specialized treatments.
• Bureaucratic Challenges: The complexity of managing UHC could lead to inefficiencies and service delays.
• Risk of Overutilization: Free or low-cost services might encourage unnecessary treatments, further straining the system.
• Sustainability Issues: Maintaining UHC long-term could be challenging, especially with growing populations or economic instability.

INITIATIVES

• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY): Offers health insurance coverage up to ₹5 lakh per family annually for secondary and tertiary care to over 10 crore vulnerable families.
• National Health Mission (NHM): Comprises the National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM), focusing on improving healthcare infrastructure in rural and urban areas.
• Rashtriya Swasthya Bima Yojana (RSBY): Provides cashless insurance coverage for hospitalization up to ₹30,000 per year for below-poverty-line families.
• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): Aims to address regional disparities in healthcare availability and enhance medical education by establishing AIIMS-like institutions and upgrading government medical colleges.
• Mission Indradhanush: Launched in 2014 to ensure full immunization of children and pregnant women, aiming to reduce child mortality and morbidity.
• Janani Shishu Suraksha Karyakram (JSSK): Provides free maternity services and care for infants in public health institutions, including free drugs, diagnostics, and transportation.
• Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP): Offers affordable generic medicines through dedicated stores, reducing out-of-pocket healthcare costs.

INNOVATION

1. Telemedicine: Virtual consultations expand healthcare access to remote areas, alleviating pressure on urban facilities.
2. Mobile Health Units: Mobile clinics deliver essential services to rural and hard-to-reach communities.
3. Blockchain for Health Records: Secure, decentralized records enhance data sharing and continuity of care.
4. AI Diagnostics: AI enhances early disease detection and supports healthcare workers with quicker, accurate diagnoses.
5. Community Health Workers: Trained workers provide basic care and education, bridging gaps between communities and formal healthcare systems.

CONCLUSION

Advancing universal health coverage requires a comprehensive approach. Strengthening healthcare systems through increased funding and improved infrastructure is crucial for ensuring access to essential services for all. Policy reforms to establish a unified health insurance system can reduce disparities and enhance affordability. Additionally, promoting community engagement and health education will empower individuals to take charge of their health, encouraging preventive care and reducing system strain. By addressing these areas effectively, we can make significant progress towards achieving universal health coverage.

KEY FACTS

• The world is off track to make significant progress towards universal health coverage (Sustainable Development Goals (SDGs) target 3.8) by 2030. Improvements to health services coverage have stagnated since 2015, and the proportion of the population that faced catastrophic levels of out-of-pocket health spending increased continuously since 2000. This global pattern is consistent across all regions and the majority of countries.
• The UHC service coverage index increased from 45 to 68 between 2000 and 2021. However, recent progress in increasing coverage has slowed compared to pre-2015 gains, rising only 3 index points between 2015 and 2021 and showing no change since 2019.
• The proportion of the population not covered by essential health services decreased by about 15% between 2000 and 2021, with minimal progress made after 2015. This indicates that in 2021, about 4.5 billion people were not fully covered by essential health services.
• About 2 billion people are facing financial hardship including 1 billion experiencing catastrophic out-of-pocket health spending (SDG indicator 3.8.2) or 344 million people going deeper into extreme poverty due to health costs.
• The COVID-19 pandemic further disrupted essential services in 92% of countries at the height of the pandemic in 2021. In 2022, 84% of countries still reported disruptions.
• To build back better, WHO’s recommendation is to reorient health systems using a primary health care (PHC) approach. Most (90%) of essential UHC interventions can be delivered through a PHC approach, potentially saving 60 million lives and increasing average global life expectancy by 3.7 years by 2030.