Universal Health Coverage

Universal Healthcare Coverage
Dr Alakananda Banerjee
President
Dharma Foundation of India
Expert Member: Senior Citizen Council Of Ministry Of Social Welfare Government of NCT Of Delhi

Key facts
• At least a billion people suffer each year because
they cannot obtain the health services they need.
• People-centred and integrated health services are
critical for reaching universal health coverage.

Key facts
• 100 million are pushed below the poverty line as a result
of paying for the healthcare services they receive.
• In the next twenty years, 40-50 million new healthcare
workers will need to be trained and deployed to meet
the need.

Universal Health Coverage (UHC)
Universal health coverage was established in the
WHO constitution of 1948 declaring health a
fundamental human right.
The goal of universal health coverage is to ensure
that all people obtain the health services they need
without suffering financial hardship when paying for
them.

Out of Pocket (OOP)Payments
• Out-of-pocket payments for healthcare services
push 100 million people globally into poverty every
year.
• If people have to pay most of the cost out of their
own pockets, the poor will be unable to obtain
many of the services they need and even the rich
will be exposed to financial hardship in the event of
severe or long-term illness

UHC and OOP
• UHC cannot be achieved overnight.
• Key factors in determining which services
are prioritized by :
1. Epidemiological context
2. Health systems
3. Level of socioeconomic development
4. People’s expectations.

Statistics
• Total population (2013)1,252,140,000
• Gross national income per capita (PPP international $,
2013)5,350
• Life expectancy at birth m/f (years, 2012)64/68
• Probability of dying under five (per 1 000 live births,
0)not available

Statistics
• Probability of dying between 15 and 60 years
m/f (per 1 000 population, 2012)242/160
• Total expenditure on health per capita (Intl $,
2012)157
• Total expenditure on health as % of GDP
(2012)4
Global Health Observatory

Access to a package of essential
services
• 1.5 million hospital beds and nearly half a million
large and small health facilities.
• An estimated 80% of hospital beds and health care
providers are in urban areas.
• The public sector :20 per cent of outpatient and 40 %
of hospitalization services.
• Private sector has nearly two-thirds of all functional
hospital beds and around 85-90 % of qualified
allopathic physicians.
• Lack of doctors/nurses in India

Delivery of Health Services
• There is an inadequate mix of promotive, preventive,
diagnostic, curative and rehabilitative services.
• In the absence of sufficient resources, the actual
availability of services in the public sector is sub-
optimal.
• The private sector largely focuses on diagnostic and
curative services.
• Moreover, those seeking care often have to go to
different facilities to access a range of services
required.

Access to Medicines
• Largest supplier of generic medicines and vaccines
globally.
• Ceiling price on 348 drugs in the National List of
Essential Medicines using the Drug Price Control
Order, 2013
• Despite some decline in out of pocket spending since
the launch of the NRHM, 60% of total healthcare
expenditure, most of which is spent on medicines, is
still borne by people out of pocket, one of the highest
in the world.

Public Health Expenditure
• India spends 4% of its GDP on health.
• According to estimates, 39 million people fall
below the poverty line every year in India due
to catastrophic healthcare expenditure.

Non Communicable Diseases (NCD)
In elderly

Goal of UHC
All people may obtain health services they need
without suffering financial hardship when paying
for them.
This requires:
1.a strong, efficient, well-run health system;
2.a system for financing health services;
3.access to essential medicines and technologies;
4.a sufficient capacity of well-trained, motivated health
workers.

Promoting factors in health systems
–Informing And Encouraging People To Stay
Healthy And Prevent Illness(prevention)
–Detecting Health Conditions Early (Early
Detection)
–Having The Capacity To Treat Disease (Curative)
–Helping Patients With Rehabilitation
(Chronic/Long Term Care)

A Call To Action
India: Towards Universal Health Coverage 7
Towards achievement of universal health care in India
by 2020: a call to action
K Srinath Reddy, Vikram Patel, Prabhat Jha, Vinod K Paul, A K Shiva Kumar, Lalit
Dandona, for The Lancet India Group for Universal Healthcare*

Healthcare for all: 2020
• Strengthen the public health system
• Reduce out-of-pocket expenditure
• Dialogue and consensus building among the stakeholders
India: Towards Universal Health Coverage 7
Towards achievement of universal health care in India
by 2020: a call to action
K Srinath Reddy, Vikram Patel, Prabhat Jha, Vinod K Paul, A K Shiva Kumar, Lalit Dandona, for The Lancet India Group for Universal Healthcare*

Share the costs across the population
• Compulsory contributions – through taxation
and/or insurance – to a pool of funds.
• Draw on these funds in case of illness,
regardless of how much they have contributed.

Government expenditure to health
• Governments need to give higher priority to health in
their budgets.
• Innovative ways:
I. Improve tax collection mechanisms.
II. Introduce levies or taxes earmarked for health, such as “sin”
taxes on the sale of tobacco, alcohol and ready to eat foods.

Resources wasted
• Globally, 20–40% of resources spent on health are
wasted
• Common causes of inefficiencies include demotivated
health workers, duplication of services, and
inappropriate or overuse of medicines and
technologies.
• In 2008 for example, France saved almost US$2 billion
by use of generic medicines wherever possible.

Existing health coverage
1. National Rural Health Mission-2005.
2. Rashtriya Swastha Bima Yojna (RSBY).
The beneficiary is any Below Poverty Line (BPL)
family,.
3. Private insurance sectors

Progress towards UHC
Financial Protection:
Responsiveness to Need:
1. Access to health care services
2. Coverage with services is monitored using utilization
data.(eg a Cancer Registry)
3. Service coverage is further supported by a
Preventive Healthcare quality bonus system.

Health Outcomes
Comprehensive Policy Monitoring And
Assessment through valid and reliable health
outcome measures

Moving forward
Plan of action: NGO/Trusts/Registered Senior
Citizen Welfare Organisations

Missing
Health System
NGO/Trust/SCWO
Private HospitalSemi-Govt (Public)Hospital
Govt. Hospital
Curative care Preventive care
Suggested Preventive Program
Corporate
Companies/g
overnment
sector
employees
Absence of
government
policies
Community Care
Centre(CCC)
Allied Health Professionals
Sugar
Obesity
Pain
Blood pressure
Dementia

Community Care Centre managed by elders
andAllied Health Professionals

Objectives of CCC
• Outreach Services
• Human Resources Development (Training of
caregivers and elderly)
• Public Health Management
• Pilots for Universal Health Coverage
• Health Management Information Systems of
the community.

Government legislations
• Compulsory annual preventive health check for
employees in government and private sector.
• Discounted preventive health packages by private
sector hospitals
• Tax rebates on preventive health packages

Benefits of UHC
• Access to health services enables people to be more
productive and active contributors to their families
and communities.
• Financial risk protection prevents people from being
pushed into poverty when they have to pay for
health services out of their own pockets.

Universal Health Coverage

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