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HOPS as a route to Universal Health Coverage

Published: 18th Apr, 2022


The lingering COVID-19 crisis is a good time to revive an issue— Universal health care (UHC). Meanwhile, UHC has become a well-accepted objective of public policy around the world.

  • And ‘Healthcare as an optional public service’ can ensure the legal right to receive free, quality care in a public institution.


  • India’s most comprehensive ‘Health Report Card’ reflects the overall change in the disease pattern in the country.
  • In 1990, 61% of the total disease burden in India was attributed to communicable, maternal, neonatal, and nutritional diseases.
  • This figure has dropped to 33% in 2016. At the same time, the contribution of non-communicable diseases (heart disease, cancers, respiratory diseases, neurological disorders) has risen to 55% from 30% in 1990.
  • Many Indian states are bigger than most countries in the world. It is necessary to plan health interventions based on the specific disease burden situation of each state.
  • The disease burden due to unsafe water and sanitation has also reduced significantly in India, but this burden is still 40 times higher per person in India than in China.
  • The contribution of air pollution to disease burden has remained high in India between 1990 and 2016, with levels of exposure among the highest in the world.
  • During COVID, India and world all together has found the importance of the Universal health care coverage programme in every Country to reduce the burden of several pandemic and future consequences.

The status of health and its essentiality calls upon to focus on universal health coverage.


What is UHC?

  • Universal health coverage (UHC) is about ensuring that people have access to the health care they need without suffering financial hardship.
  • UHC is also an essential part of the Sustainable Development Goals (SDGs): SDG 3 includes a target to “achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all”.
  • SDG 1, with the goal to end poverty in all its forms everywhere, is also in peril without UHC, as hundreds of millions of people are impoverished by health expenses every year.

Universal health coverage and health financing

  • UHC 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.

Objectives of Universal health coverage

  • Equity in access to health services - everyone who needs services should get them, not only those who can pay for them.
  • The quality of health services should be good enough to improve the health of those receiving services.
  • People should be protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm.
  • Universal health coverage: Challenges
    • The total expenditure on health care in India, including public and private expenditure is broadly comparable to other developing countries at similar levels of per capita income.
    • The total expenditure on health care (both public and private together) is 3.7 per cent of the GDP.
    • According to the World Health Statistics 2013, public expenditure on health very low constitutes 28.2 per cent of total health expenditure.
    • According to the Government of India’s 12th Five Year Plan, public health expenditure in India was only 1.04 per cent of GDP in 2011–12 as compared to the global average of 5.4 per cent.
  • Current Operating norms:
    • The Union Government’s Ministry of Finance disburses funds to the Ministry of Health and the States.
    • The public sector also funds a number of insurance schemes.
    • Currently, Union-funded insurance schemes cover an estimated population of 181 million through the Employee State Insurance Scheme (ESIS) – (60 million); Central Government Health Scheme (CGHS) – (3 million) and Rashtriya Swasthya Bima Yojana (RSBY) – (118 million).
  • Other related schemes in India for health:
  • Ayushmaan Bharat yojana (AYUSHMAAN)-providing 5 lakh rupees per person for every family in a year.
    • Janshree Bima yojana.
    • Pradhan mantri Suraksha Bima yojana.
  • Structural ambiguity on UHC:
    • What services are to be universally provided to begin with?
    • What level of financial protection is considered acceptable?
    • Should UHC commence by offering the same set of services to the entire population and progressively expand the service package to all as more resources accrue?
    • Should UHC first prioritize certain services to the poor and vulnerable sections, to ensure both access and affordability, while leaving the rest of the population for coverage at a later stage?
    • There is an option to provide a basic package of services to all, with full financial protection, along with an additional set of publicly funded services to the poor and vulnerable sections.
  • The Operational foresight:
    • To meet the standard set by the WHO and the SDGs, UHC has to include all persons in a population, even if the service package is modest to begin with.
    • In terms of financial protection, the Out Of Pocket Expenditure (OOPE) on health should not exceed 15-20 per cent.
    • This requires a high level of public financing.
    • Even countries which follow an insurance model have a high level of public funding to support several health services.
    • Mandated contributory insurance model will not work in India which has over 90 per cent of the workforce in the informal sector.
  • How does India measure up presently and can it achieve the 2030 target?
    • OOPE is still around 63 per cent, despite several government health insurance and benefit schemes.
    • Impoverishment due to unaffordable healthcare expenditure affects 7 per cent of our population.
    • Healthcare induced financial distress is a leading cause of suicide among farmers.
    • Access to health services varies widely among states and between rural and urban populations.
    • Qualified healthcare providers are in short supply nationally and those available are maldistributed, with marked density differences across regions.

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