Is India ready for universal health coverage?

By Jisha Krishnan

Published on 6, June, 2018

At the recently concluded World Health Assembly in Geneva, India has committed to achieving universal health coverage (UHC) for its citizens. Touted as the largest government-funded health protection scheme in the world, Ayushman Bharat-National Health Protection Mission (AB-NHPM) aims to cover 500 million Indians from 100 million families across the country. About 40 per cent of the country’s population is expected to be provided with an annual insurance cover of Rs 500,000. 
Does all this sound too good to be true?
Ground realities
Of its 1.3 billion population, over 1 billion Indians are currently uninsured. At 62 per cent, Indians account for the highest ‘out of pocket expenditure’ in the world for healthcare. What’s more, studies show that of the 100 million people who are pushed into extreme poverty each year due to unaffordable medical expenses, 70 million are from India!
According to a recent study by the Federation of Indian Chamber of Commerce and Industries (FICCI), in 2017, there were 0.9 hospital beds per 1000 people in the country. Similarly, there were only 10,22,859 doctors in the country. In other words, 0.59 doctors per 1000 population, as against the World Health Organisation (WHO) recommendation of a minimum of one doctor per 1000 population.
Besides, the government spending on healthcare is a paltry 1.4 per cent of the GDP. As per the ambitious National Health Policy 2017, even if we raise the public health expenditure to 2.5 per cent of the GDP by 2025, we will be nowhere close to the global average of 5.9 per cent. Incidentally, the FICCI study finds that India’s public health expenditure needs to be in the range of 3.7 to 4.5 per cent of the GDP for its UHC scheme to be successful.
The big picture
UHC, according to the WHO, means that all people and communities 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. While we focus on better access to healthcare, it’s important not to overlook the quality factor. 
A fascinating study by BMJ (Rethinking assumptions about delivery of healthcare: implications for universal health coverage) conducted in association with the Harvard Global Health Institute challenges long-held hypotheses about public healthcare with data-backed findings. For instance, how often have we heard that primary care providers are overburdened with patients and therefore unable to offer the best quality of care? The study found that the average healthcare provider in a public clinic in rural India sees 5.7 patients a day, spending only three minutes with each. Which means, s/he spends less than 18 minutes a day seeing patients!
Simply providing access to trained medical professionals and facilities cannot guarantee universal access to quality care. We need to address the yawning gap between knowledge and practice. We need to ensure that doctors and other staff are trained as well as motivated to do their best.
Making it happen 
We need to learn from countries like Thailand, Japan, Turkey, and Germany, where UHC is making use of data through advanced information systems for improved healthcare outcomes. Apart from the political will, funding, enthusiastic healthcare providers, and solid planning, a mammoth project like UHC also demands collaboration. Well-defined public-private partnerships are the way to go. Especially in a country like India, where 80 per cent of outpatient and 60 per cent of inpatient care is delivered by the private sector. 
So, back to our original question: Is India ready for UHC? Well, not quite. But we need to set the ball rolling. With renewed emphasis on prevention and primary health care, we can get there. Sometime in the future.