ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Ayushman Bharat

The Pradhan Mantri Jan Arogya Yojana is an ambitious health insurance scheme that has been touted as an important tool to achieve universal health coverage. However, there is still no clarity regarding the financial implications of this scheme. Based on National Sample Survey data of 2004 and 2014 on hospitalisation rates and average medical expenditures, three alternate scenarios have been analysed based on different assumptions about these two parameters, to estimate the total costs of the programme. The results indicate a potentially high burden of the programme on the state and union government finances, especially if it is successful in covering all the intended beneficiaries.

Designing a Framework for Benefit Packages

Development of an essential health package requires explicit prioritisation on the basis of a country’s characteristics. A practical framework is presented to determine an EHP, considering coverage and equity perspectives for service delivery, financial protection and morbidity burden in the population. An analysis of morbidity data, unmet need for treatment, and impoverishment due to out-of-pocket spending reveals that a significant reduction in oop expenditure and impoverishment is possible through targeted inclusion of potentially high impoverishment-causing morbidities in EHPs. Such an approach may offer the desired flexibility in decision-making to policymakers, without compromising on benefits transferred to the needy.

Governance Performance of Indian States

Building on a methodology developed in an earlier paper, the results of an exercise in ranking Indian states based on five sets of criteria--infrastructure, social services, fiscal performance, justice, law and order, and quality of the legislature--are presented to show how states have fared relative to each other between 2001-02 and 2011-12. What emerges is that five of the six best-performing states of 2001 were also the best performers in 2011. Similarly, four of the six worst performers of 2001 were also among the worst performers of 2011. A consequence of such stickiness of rankings at the top and the bottom is growing regional disparity between the more- and less-developed states.

Public Financing for Health Coverage in India

Any discussion on universal health coverage in India is premature without a comprehensive understanding of public financing of health coverage in the country. This article analyses the government's share of financial resources for health across different agents, with particular focus on resources for health coverage. An attempt is made to separate spending for health in general and health coverage in particular, and to examine the issue of equity. The analysis indicates that the present health coverage system is inadequate and iniquitous, with various systems running at different costs. It suggests consolidating finances and moving towards a more unified system to realise the benefits of efficiency gains.

The Quality of Governance

There is a core concept of good governance, the combination of authority and responsibility to pursue the common good, that has remained stable over millennia. Building on this concept the paper develops several indices of the quality of governance and applies these indices to rank major states in India. The governance indices have been derived from the three main pillars of the government, i e, the legislature, the judiciary and the executive. Performance on each dimension of governance has been measured using indicators that are all based exclusively on factual data, not perceptions. The paper shows that there is a strong correlation between governance quality and the level of development in a state. When we correct for the effect of development on the quality of governance, it turns out that some of the poorer states significantly improve their rank, implying their governance performance is much better than would be expected at their level of development.

Financial Burden of Transient Morbidity: A Case Study of Slums in Delhi

Morbidity and its treatment can be potentially burdensome or even catastrophic for poor households. While public policy has shown some response to this phenomenon, there is scope for improvement of the coverage of the programmes. Health insurance schemes like the Rashtriya Swasthya Bima Yojana cover only conditional hospitalisation expenses. This paper argues that treatment cost incurred on ailments not requiring hospitalisation is also a substantial burden on the urban poor. Based on a case study of 150 slum households in south Delhi with a history of treated ailments within a specific recall period, the study estimates the degree and distribution of this burden across socio-economic and disease characteristics in the sample. The paper argues for a more holistic approach in social safety nets like the RSBY, and for explicitly including uncovered healthcare payments in measurement of the poverty lines for a more accurate estimation of the marginalised.
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