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

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Political Challenges to Universal Access to Healthcare

While welcoming the report of the High Level Expert Group on Universal Health Coverage for India for its comprehensive vision and many well-conceived recommendations, this article focuses on the conditions needed for its promise to bear fruit. Towards this, it explores the political dimension, which comprises the forces and interests that come into play to shape and reconfigure administrative policy and its implementation.

Human Resources in Health

A close look at the major recommendations on human resources in the report of the High Level Expert Group on Universal Health Coverage for India shows that most of them are timely and have been made in the right spirit. Some lacunae do exist, especially on medical education and specialisation. But the most important issue is whether the recommendations can and will be efficiently implemented to give shape to a non-competitive, high quality medical system that provides all possible preventive and curative services to every citizen in the country.

In Pursuit of an Effective UHC

There are certain bold directions outlined by the High Level Expert Group in its recommendations, which, if acted on, will have a great impact on the health status of the population. The key as always is in implementation, which has not been clearly spelt out.

Thailand's Universal Health Coverage Scheme

Thailand achieved universal health coverage by 2002 with three public health insurance schemes covering the entire population. Of these, the Social Health Insurance scheme for private sector employees has been run on a capitation contract model since 1991. The Universal Coverage Scheme followed its example, with capitation payments for outpatient services and a global budget with diagnosis-related group-based payments for inpatient care. There are several arguments in favour of this closed-end payment system such as administrative simplicity, efficiency, prevention of supplier-induced demand and long-term cost containment.

Medicines for All

The recommendations on access to medicines, vaccines and technology made in the report of the Planning Commission's High Level Expert Group on Universal Health Coverage for India are welcome and should go a long way towards rectifying many existing problems. Yet, it would have been reassuring if a few more details had been spelled out. Given the array of vested interests that stand to lose out if they are implemented, it also remains to be seen if they will be accepted in full.

A Limiting Perspective on Universal Coverage

The report of the High Level Expert Group on Universal Health Coverage for India reaffirms the principles of universality and equity in access to healthcare and the central role public services have to play in bringing this about. However, the HLEG pays inadequate attention to regulating the deeply entrenched private health sector, which is not only embedded within an intricate and interdependent web of power relations, but also has a marked influence on policy.

Gender in the HLEG Report

Apart from referring to gender concerns in its chapters addressing critical areas of the healthcare system, the High Level Expert Group's report on Universal Health Coverage for India has a separate chapter on gender and health. While the report as a whole and this chapter make several sound suggestions, what comes through is that much more could have been done. In the absence of a gender and health analysis framework, the report tends to address gender issues in an ad hoc and uneven fashion.

Universal Health Coverage in India

India's steps towards universal health coverage began in the early years after Independence but they faltered because of various factors, including resource constraints. The context has vastly changed since then but the need remains as urgent as it always was. This overview to the special issue on the report of the High Level Expert Group on Universal Health Coverage notes that the report takes into account the complex nature of the health situation in the country and puts forth an integrated blueprint for achieving UHC. There may be a few shortcomings, but if the interlinked proposals are implemented in a carefully planned manner, a long-delayed promise to the country's people could be largely fulfilled.
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