Universal Health Coverage: Policy Implications

Universal Health Coverage (UHC) has been designated as a target for the United Nations Sustainable Development Goals. UHC is relevant to each and every nation as the health priority across the world includes equity in the use of health services, services' quality and financial protection of the community. The aim is to facilitate the population with a range of important health services covering 100 per cent of their medical needs and making sure they avail these services without incurring health expenditure which is over 10 per cent of the monthly household expenditure. Medical cost is one of the main causes of poverty in India, as the health sector is chiefly dependent on out-of-pocket expenditure and accessing healthcare from private firms.

Manisha Jindal, Dean, Sharda School of Medical Sciences states, "Universal health policy means everyone has health insurance and medical benefits and it ensures people safety from health risk without incurring financial problems. It leads to an increase in the healthy population of the country. Whereas the drawback of this policy is the overall quality and variety of care declines."

She further adds, "In some countries with universal healthcare, patients see long wait times or even have to wait months to be seen at all. Access, quality, availability, adaptability, choice and Innovation - as countries work toward UHC, these principles may offer guidance to policy makers, industry and other stakeholders who seek to improve healthcare and meet the health needs of all citizens."

Primary indicators in the UHC framework

Equity - Is there an equitable distribution of healthcare services across population groups?

Financial risk protection - Will people be unable to access health services or become impoverished asa result of out-of-pocket payments?

Coverage - How many people are getting the health care they require? 

In the Indian context, until recently there has been lack of political commitment in recognizing health as an important component of human development. This led to low investment, lack of sound process for policy formulation and inappropriate health program implementation, which in-turn leads to inadequate delivery of health care by the general public sector. UHC isn't merely an aspirational goal but an entitled provision. It ceases to be a system of health insurance but conceptually is an assurance of medical care.

Sudarshan Ballal, Chairman, Manipal Hospitals, suggests, "The key features we need to work on are to strengthen preventive, public and primary healthcare, strengthen the government hospitals, boost health care infrastructure and train more health care workers specially to work in rural areas, promote digital health and build a robust viable public private partnership. If all of this happens we would have achieved the goal of health for all and a healthy India."

"The unending misery of the COVID pandemic has made it very clear to the entire world that any country is only as strong and safe as her healthcare system is," adds Ballal.

Policy initiatives

Effective implementation of UHC might be achieved through consensus among the govt, private sector, civil society and health care provider associations. Citizen engagement should be promoted at the institutional level, which can promote community participation in health planning, implementation and review. This permits mechanisms being more aware of the requirements of the communities including local accountability. Involvement of formal and informal leaders will enable public deciding and improving the method of policy formulation. Operational deficits tend to exist within the current village level health and sanitation committees, thanks to low capacities and ambiguity of roles. These gaps should be addressed through training for strengthening capacities and establishing mechanisms for greater oversight by the community.

The UHC based health system should efficiently regulate the complex and dynamic nature of the private healthcare sector. The market competition and choices generated therewith should be used as tools to reinforce the standard of care and reduction of cost. The pluralistic UHC driven healthcare system should enable the engagement of multiple stakeholders, because the social determinants of health influence the equitable distribution of healthcare.

Conclusion

The objectives of UHC got to be evaluated not at the individual but at the population level. The way forward is to develop a comprehensive integrated insurance service which is financed through a mixture of public sector funds, occupational coverage and personal sources for ensuring provision of health look after all, including vulnerable individuals like from poor or rural background, children and elderly age bracket. In view of the present COVID crisis and the need to address future pandemics, we need to create resilient health systems and also hasten the implementation of UHC.