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

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Draft National Health Policy 2015

This paper contributes to the debate on the Draft National Health Policy 2015 by analysing and critiquing some of its key recommendations within the prevailing social, economic, and political context of the country. This policy seems to suggest that strategic purchasing of curative health services from both the public and private sectors can enable India to achieve the goal of "universal healthcare." The draft policy is based on two assumptions. One, policy interventions since the National Health Policy 2002 have been largely successful and two, there is harmony of purpose between public and private healthcare delivery systems which allows the private sector to be used for achieving public health goals. This article argues that these assumptions are flawed, highlights the various contradictions in the policy and cautions against over-optimism on publicly-financed health insurance schemes.

Improving Healthcare Services at Reduced Prices

The key to improving the quality of healthcare services in India and reducing costs at the same time can be found by enacting legislation which lays down minimum standards of patient care. In the absence of such standards and the reluctance of health insurance companies to standardise either price or quality, healthcare services continue to be expensive and of doubtful quality. Developing standards of patient care by legislative mandate and a change in the attitude of health insurers can change the equation in favour of the patient who is now at the mercy of the hospital.

Measuring Progress towards Universal Health Coverage

This paper proposes an approach to periodically measure the extent of progress towards universal health coverage using a set of indicators that captures the essence of the factors to be considered in moving towards universalisation. It presents the rationale for the approach and demonstrates its use, based on a primary household survey carried out at the district level. Discussing the strengths and limitations of the approach, it points to how these measures could be further refined. The effort is to find a method of measurement that will apply to any of the alternative ways of progressing towards universal health coverage, however defined and implemented.

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.

Health Service System in India

Universalising health coverage is the current goal of the health service system in India. Tax-funded insurance for poor families is the method chosen for attaining this objective. The Rashtriya Swasthya Bima Yojana was rolled out in 2008 for households below the poverty line, enabling them to access health services in the public and private sectors. However, experience from different countries shows tax-funded insurance systems work well only in settings where public provisioning of healthcare services prevails. State-funded targeted insurance schemes do not seriously mitigate inequitable access to health services in a fundamentally private healthcare delivery market.

Universal Health Coverage

For India to improve the existing government health system is far less complex than expanding health insurance. International experience shows the difficulties of regulating an insurance-based system to keep costs down and assure quality.

Risks and the Budget

In the Budget for 2003-04 the government has sought to underwrite risks faced by different segments of the population. When governments assume additional risks it is necessary to ask whether the mode of risk mitigation proposed is appropriate and who would benefit from such intervention. An attempt is made here to examine these and related questions in relation to the budget.

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