Universal Health Coverage in India: Reducing the Poor’s Health Burden

Syllabus: GS2/ Health, Management of Social Sector, Issues Relating to Poverty & Hunger

•Source: IE*

Context: Over the past decade, the poorest in India have become less vulnerable to medical expenditure shocks, largely due to the Ayushman Bharat Yojana. Expanding it to reach near Universal Health Coverage in India becomes important for India to reduce the Poor’s Health Burden.

Major data points from the article on the success of Ayushman Bharat Yojana:

• Health Expenditure Trends: With hospitalization: Health expenditure decreased from 10.8% to 9.4% of monthly household expenditure.

• Rural vs. Urban Areas: Rural households with hospitalization: Health expenditure decreased from 11.15% to 9.14%. Urban households with hospitalization: Health expenditure decreased from 10.3% to 9.9%.

• Impact on Consumption Status: In 2011-12, 40% of the bottom 50% of households facing hospitalization experienced a decline in consumption status. By 2022-23, this percentage decreased to 33%.

• Hospitalization Incidence: Increased from 17% in 2011-12 to 22% in 2022-23 for the bottom 50% of the population.

• Public Health Policy Impact: Notable improvements in healthcare affordability and accessibility for the poorest, especially in rural areas and among households with young children or elderly members, are attributed to the Ayushman Bharat Yojana.

What is UHC?

Universal Health Coverage (UHC) refers to a healthcare system where all individuals and communities have access to the quality health services, they need without facing financial hardship. Access to quality healthcare is a fundamental right for all individuals, rather than a privilege reserved for a few.

Status:

• The Indian Constitutional provisions (Art. 39E, 42, 47) mandate the State to secure workers’ health, improve living standards, and enhance public health.

• The United Nations designated December 12th as International Universal Health Coverage Day (UHC Day) in 2017

• Sustainable Development Goal 3.8 aims to achieve universal health coverage

• India aims to achieve Universal Health Coverage (UHC) by expanding the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), its flagship publicly financed health insurance (PFHI) scheme

Challenges in Implementing UHC in India:

Challenges | Description

Inequitable Access to Health Insurance | Lowest health insurance coverage among households under the underprivileged sections.

NFHS-5 results show only about 36% coverage among lowest lowest-wealth households.

Poor Finance | India’s current health expenditure stands at approximately 3.2% of its GDP, significantly lower than the average of around 5.2% observed among Lower- and Middle-Income Countries (LMIC).

Lack of Financial Protection | Despite schemes like Janani Shishu Suraksha Karyakram, high out-of-pocket expenditure for deliveries, particularly in urban areas

Inclusion and Exclusion Errors | Government Schemes are prone to inclusion and exclusion errors, potentially including ineligible households and excluding eligible ones.

Inadequate Availability of Services | 56% of PMJAY empanelled hospitals in the public sector, and 40% in the private for-profit sector, indicating unequal service availability

Inadequate Infrastructure | Lack of proper infrastructure, including health facilities, equipment, and medical supplies, hinders UHC

The shortfall of over 79% specialists at Community Health Centers compared to the requirement.

Lower bed density: (number of hospital beds per 1000 population) in India is 1.0 while in low-income countries it is 1.2, in middle-income countries it is 2.4 while in the world it is 2.7. 72 per cent of hospital beds in India are available in urban areas, while 28 per cent are in rural areas.

Poor Health Education | Lack of education and awareness about healthy lifestyles and preventive measures contributes to preventable illnesses and conditions.

72 per cent of hospital beds in India are available in urban areas, while 28 per cent are in rural areas.

In line with the objectives of UHC, the government has taken the following measures:

• Ayushman Bharat: Launched in 2018. It consists of two components: Health and Wellness Centers (HWCs) and the Pradhan Mantri Jan Arogya Yojana (PMJAY). PMJAY provides health insurance coverage. A study in 2021 found the scheme is associated with a 21% decline in out-of-pocket health expenditure.

• A study in 2021 found the scheme is associated with a 21% decline in out-of-pocket health expenditure.

• National Health Mission (NHM): aims to provide accessible, affordable, and quality healthcare to rural and underprivileged populations. Utilization of public health facilities for institutional deliveries increased from 56% to 69% in rural areas by 2019.

• Utilization of public health facilities for institutional deliveries increased from 56% to 69% in rural areas by 2019.

• National Ambulance Service-102: Setup as part of the National Health Mission, operates 20,990 Emergency Response Service Vehicles. The ‘108’ service aims at responding within the ‘golden hour’.

• The National List of Essential Medicines (NLEM) and the Essential Diagnostics Lists have been notified and are periodically updated to ensure the availability of more essential, The National Phrama Pricing Authority (NPPA) is set up to monitor the availability of drugs, identify shortages, if any, and to take remedial steps.

• The National Nutrition Mission has set an objective of reducing the undernutrition, problems of stunting by 2%.

• Under India’s G20 presidency, WHO launched the Global Initiative on Digital Health to boost investments and facilitate international health exchange.

• Increasing doctor population ratio: 1:854 is better than the World Health Organisation’s standard of 1:1000. The number of UG (undergraduate) seats has increased from 51,348 before 2014 to 91,927 in 2022, which is an increase of 79 per cent. Under the Central Sector Scheme for setting up new AIIMS, 22 AIIMS have been approved and undergraduate courses have started in 19 AIIMS.

• Under the Central Sector Scheme for setting up new AIIMS, 22 AIIMS have been approved and undergraduate courses have started in 19 AIIMS.

Technology can be leveraged in the following ways to further augment it:

• Telemedicine: allows remote consultation and diagnosis, enabling patients in rural and remote areas to access healthcare services. National telemedicine service of India, eSanjeevani achieved 8 crore teleconsultations in 2022.

• National telemedicine service of India, eSanjeevani achieved 8 crore teleconsultations in 2022.

• Electronic Health Records (EHR): can enhance the efficiency and accuracy of healthcare delivery. The health ID provided for each patient will be a repository of his health-related information.

• Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure.

• Mobile Health (mHealth): mHealth is an emerging concept involving the utilization of mobile devices and technology for health services, such as appointment scheduling, remote monitoring, and medication reminders.

• Artificial Intelligence (AI): analyses large amounts of health data, identifies patterns and trends, and provides insights for developing new treatments and therapies thus reducing the workload of healthcare professionals and enhancing diagnostic accuracy.

• IoT: The Internet of Things connects vital monitoring equipment giving a composite picture of the health of patients

Conclusion:

Ensuring healthcare as a right for all citizens is not only a moral imperative but also a key driver for social development and economic progress. WHO recommends reorienting health systems using the primary healthcare (PHC) approach, which can deliver 90% of essential UHC interventions. India should build on existing systems, implementing reforms and best practices incrementally for a healthier, more prosperous future.

Insta Links:

Moving forward with a newer concept of Universal Healthcare

Prelims Link:

With reference to the National Rural Health Mission, which of the following are the jobs of ‘ASHA’, a trained community health worker? (UPSC 2012)

• Accompanying women to the health facility for antenatal care check-up

• Using pregnancy test kits for early detection of pregnancy

• Providing information on nutrition and immunisation.

• Conducting the delivery of the baby

Select the correct answer using the codes given below:

(a) 1, 2 and 3 only (b) 2 and 4 only (c) 1 and 3 only (d) 1, 2, 3 and 4

Ans: (a)