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

Healthcare: Global

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.

Key Point: Definitions

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 context2. Health systems3. Level of socioeconomic development 4. People’s expectations.

Healthcare: India

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

Global Health Observatory

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 UHCAll 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 7Towards achievement of universal health care in Indiaby 2020: a call to actionK 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 7Towards achievement of universal health care in Indiaby 2020: a call to actionK 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 UHCFinancial 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 Hospital Semi-Govt (Public)Hospital Govt. Hospital

Curative care Preventive care

Suggested Preventive Program

Corporate Companies/government sector employees

Absence of government

policies

Community Care Centre(CCC)

Allied Health ProfessionalsSugarObesityPainBlood pressureDementia

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.

QUESTIONS?QUESTIONS?