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

Articles By Health Policy and Legislation

NITI Aayog’s Health Index

Based on a critical review of the NITI Aayog’s recently published “Healthy States, Progressive India,” it is argued that the report provides only a superficial insight into the overall health attainment. Much deeper and careful analysis is required if one aims to unfold the complexity and varied contexts provided by Indian states, let alone ranking them on health attainment. The method of calculating the index in the report compromises scientific rigour, and the inferences drawn are highly misleading.

 

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.

Public Health Systems and Privatised Agendas

Examining how health policy has fared in India during the last five years shows the constriction of finances for major programmes like the National Health Mission and Reproductive and Child Health Programme that has led to under-resourced public systems. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana health insurance scheme would only end up diverting public resources towards commercial insurance companies and private hospitals, while having doubtful benefits for community health.

Utilisation, Fund Flows and Public Financial Management under the National Health Mission

Since April 2014, funds for various centrally sponsored schemes, including the National Health Mission, are being transferred to implementing agencies through state treasuries. This has added an additional layer in the institutional structure for nhm fund flows. We analyse the utilisation of nhm funds in 29 states in two recent years, and the time taken for release of these funds from state treasuries to implementing agencies in three selected states: Bihar, Maharashtra, and Odisha. On average, only about 55% of funds allocated for nhm were utilised in 2015–16 and 2016–17. In Bihar and Maharashtra, this was partly due to significant delays in release of funds from state treasuries to implementing agencies. The delays were a result of complex administrative procedures associated with the release of nhm funds from state treasuries.

Compulsory Licensing of Pharmaceutical Patents in India

The trend of continued rejection of compulsory licence applications in India goes against the local generic drug manufacturers and public health safeguards incorporated in the Indian patent law. It raises serious questions about the intervening role of the state in patent monopoly to equalise the competing interests between patent holders and consumers of “public good.” This trend indicates a policy shift of the government regarding compulsory licensing.

Estimating Public Spending on Health

The use of information on withdrawals by Drawing and Disbursing Officers for improving the estimates of public spending for National Health Accounts in India is illustrated. Using information from Karnataka and Rajasthan, the study highlights the advantages of combining DDO-level information with budgetary data. The significant benefits of using DDO-level information in India have implications for better estimates of public spending and health policy design.

Flaws of Insurance-based Healthcare Provision

Tamil Nadu is recognised for its achievements in human development, especially in the area of healthcare. In light of the central government’s recent move to launch insurance-based targeted healthcare provision, a case is made for paying attention to building public health infrastructure based on Tamil Nadu’s experience with healthcare provisioning. The pitfalls of insurance-based provisioning and targeting, and the need to recognise regional trajectories and institutional innovations in this regard are highlighted.

How Equitable Will Ayushman Bharat Be?

Ayushman Bharat holds the promise to advance equity both within households as well as across social groups. However, the geographical inequities characteristic of India’s healthcare provisioning need to be overhauled first for the scheme to be more equitable.