Universal health coverage concept and vision for india

Editor's Notes

1. Universal coverage - three dimensions The path to universal coverage involves important policy choices and inevitable trade-offs. The way the pooled funds – which can come from a variety of sources, such as general government budgets, compulsory insurance contributions (payroll taxes), and household and/or employer prepayments for voluntary health insurance - are organized, used and allocated, influences greatly the direction and progress of reforms towards universal coverage. The pooled funds can be used to extend coverage to those individuals who previously were not covered, to services that previously were not covered or to reduce the direct payments needed for each service. These dimensions of coverage reflect a set of policy choices about benefits and their rationing that are among the critical decisions facing countries in their reform of health financing systems towards universal coverage. Choices need to be made about proceeding along each of the three dimensions, in many combinations, in a way that best fits their objectives as well as the financial, organizational and political contexts. Extending the coverage from pooled funds along the three dimensions calls for health financing reforms and actions leading to an increase of available funds for health, to an increase in the share of these funds collected through prepayment and the arrangements for pooling them, to efficiency gains and to upholding and increasing the quality of the health services. More on health system funding More on prepayment and pooling More on increasing health system efficiency and equity In the section on country developments, more can be learned on the technical and political choices countries have taken in order to expanded coverage along the three axes. More on country development
2. The path to universal coverage involves important policy choices and inevitable trade-offs. The way the pooled funds – which can come from a variety of sources, such as general government budgets, compulsory insurance contributions (payroll taxes), and household and/or employer prepayments for voluntary health insurance - are organized, used and allocated, influences greatly the direction and progress of reforms towards universal coverage. The pooled funds can be used to extend coverage to those individuals who previously were not covered, to services that previously were not covered or to reduce the direct payments needed for each service. These dimensions of coverage reflect a set of policy choices about benefits and their rationing that are among the critical decisions facing countries in their reform of health financing systems towards universal coverage. Choices need to be made about proceeding along each of the three dimensions, in many combinations, in a way that best fits their objectives as well as the financial, organizational and political contexts.
3. 2010 World Health Report builds upon the 2005 WHA recommendations and aims at assisting countries in quickly moving towards universal coverage.'5 The report highlights three basic requirements of universal health care: raising sufficient resources for health, reducing financial risks and barriers to care, and increasing efficient use of resources. '
4. The ambit of universal health coverage will include not only the poor, but also includes those that relatively better off, so that they have an interest in building and benefiting from an efficient and equitable health system. The democratization of healthcare through UHC should enable individuals, groups and communities to improved access to healthcare services and empower them to make better health choices. Empowerment could take various forms and can be at multiple levels e.g., behaviour change to avoid risk, training of community health workers, community monitoring of health services, and demand generation for attention to local health concerns. promotive, preventive, curative and rehabilitative care at primary, secondary and tertiary levels that covers the broadest range of health conditions possible. Health care providers must be competent, and infrastructure, equipment, essential medicines, laboratory investigations, medical supplies and patient transport must be sufficiently and equitably available The benefits and continuity of coverage under UHC should be available to any person or family moving across the country. Migrant workers, those changing place of residence across states, districts or cities, beneficiaries of any health insurance programme, and those who change employers or become unemployed should be assured continuity of care Indian context, a substantial increase in tax-based public financing is required to finance UHC, given the relatively small proportion of the population employed in the formal sector.