ABSTRACT
India has embraced and consistently endorsed the idea of universal health coverage (UHC) as a prerequisite for improving people’s health. However, three key aspects limit India’s approach to UHC. Firstly, the insufficient attention to primary healthcare has resulted in many parts of the country still falling short of universal access. Secondly, the reliance on medical insurance schemes by the government to provide financial protection to poor and vulnerable population is fundamentally flawed. This approach excludes a large segment of the population that also needs affordable and reliable healthcare. Thirdly, the chronic underinvestment in the public sector in health poses a major obstacle. No country has achieved anything close to UHC without the presence of a strong public sector in health. Unfortunately, the underfunding of health by the state has meant that the much-needed government healthcare, especially in rural and remote areas, is not available to a vast majority of the population. The low levels of public spending on health has also led to the unbridled expansion of an unregulated ‘private sector’ largely providing health services of dubious quality.
Moving forward, India must fundamentally reassess its approach to achieving UHC. Central and state governments should prioritise health, especially primary healthcare, by significantly increasing public investment. There is no alternative for the government but to spend more and spend better to enhance the public sector’s capacity to meet UHC goals. Efforts should include empowering individuals by expanding access to primary healthcare and strengthening local health delivery systems, supported by the decentralisation of funds to states. The expansion of government health services should be paired with efforts to regulate and curb the unchecked growth of the private healthcare sector. A new regulatory framework is needed to ensure that the private sector contributes responsibly to UHC. India should transition away from an insurance model that only provides financial protection to the poor and vulnerable, and move towards a tax-funded, public sector-led system that offers affordable, quality healthcare to all citizens. These fiscal and governance reforms are within the reach of a country with India’s resources. A stronger political will and resolve to advance health well beyond current efforts is required.
