This digital artifact is intended to inform the Indian Government of the ways it can finance the Universal HealthCoverage, an essential post of the Sustainable Development Goals. Healthcare is a necessity and people inIndia are unable to access basic healthcare services due to high cost. The presentation summarizes theconcept of Universal Health Coverage, its importance in fulfilling the Sustainable Development Goals and waysto finance it.The presentation cites data to show how healthcare is neglected and the government spending is one of thelowest in the world. Ways in which the government can raise sufficient financial resources are suggested.

Financing Universal Health Coverage in India

Health: A HUMAN RIGHT

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social

services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control

- Article 25.1 of the Universal Declaration of Human Rights

Under-nutrition in some parts of India is worse than Sub-Saharan Africa

Source: Wall Street Journal http://s.wsj.net/public/resources/images/OB-RH905_imalnu_G_20120110090323.jpg

Health Financing in IndiaDirect fee for service (Out of pocket expenditure) is a significant barrier for accessing healthcare

OOP (private at the point of delivery of service) is 70% of the Total Health Expenditure in India

Healthcare costs are the biggest cause of poverty in India, points the National Sample Survey 64th round data

Government spends close to 1% of its GDP on Healthcare (one of the lowest in the world)

Direct relationship between health status and direct payments

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Out of Pocket expenditure as a % of Total Health Expenditure

India

What is UHC?

“Ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship”

- World Health Organization

UHC

Why UHC?

UHC is a critical and often cost-effective element in any strategy to address poverty and social exclusion, key pillars of the post- 2015 sustainable development agenda.

SIXTY-FOURTH WORLD HEALTH ASSEMBLY WHA 64.9 Agenda item 13.4

Source: Twitter handle - @WBG

Components of UHC• Include other services

• Reduce cost sharing

• Extend to non-covered

Source: http://www.who.int/health_financing/strategy/uc_cube_med.gif

Principle on which Financing UHC rests

World health Organization asked its member states to ensure that health-financing systems avoidsignificant direct payments at the point of delivery.

Financing StructureExternal

aid

Private

Public

• The maximum share should be by government

• Followed by the private expenditure

• Least as external aid

Public Financing

Obstacles:

Low spending by the governments ( 1% of GDP)

Competing priorities (other social sectors, defence etc.)

High informal payments

Inefficient

How Can the Government Raise the Financial Resources?

Tax revenue as a percentage of GDP is 10-15% (LOW)

Solution - There is a great scope of increasing it to 23-30% which will provide additional funds to the government to finance UHC and other social sector areas

Tax base (NARROW)

Just 35million constitute the tax base although 100million people are registered with the income tax department

Solution – Tax base needs to be broadened

Source for tax revenue to GDP ratio: http://data.worldbank.org/indicator/GC.TAX.TOTL.GD.ZS

Continued…

Inefficiency/Leakages (HIGH)

India ranks 85th in the Transparency Perception Index

Solution: Government should take proactive steps to rout out corruption which will prevent leakages and increase its revenues

Allocative efficiency (LOW)

Solution: The government should spend more on primary care which provides care to a largenumber of people rather than spending a lot of money on costly tertiary care hospital. Out ofPocket spending on medicine is 70% of the total OOP on Healthcare. Therefore, prioritisingreduction in cost of medicine would lead to a considerable decline in the OOP on Healthcare .

How to Use the Private Sources of Financing?Government must improve the ease of doing business followed by proper regulation of the private sector.

Use of impact investing can lead to opening up of the healthcare sector where pension funds and other such funds can be invested in the healthcare market.

Multilateral/Bilateral AssistanceThe government should use the external aid in capacity building which leads to reduced inefficiency in tax administration.

Further external assistance can be used in areas which lead to increased expertise in handling emergency disease outbreaks.

Thank You