Journal Article

Assuring health coverage for all in India

Nandraj, Sunil, Kumar, A K Shiva, Patel, Vikram, Chatterjee, Mirai, Reddy, K Srinath, Parikh, Rachana, Narayan, Kavita, Paul, Vinod K, Balasubramaniam, Priya

2015

Overview

Successive Governments of India have promised to transform India's unsatisfactory health-care system, culminating in the present government's promise to expand health assurance for all. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for India's health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022—a fitting way to mark the 75th year of India's independence.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Age / Children & youth / Commercialization / Corruption / Cost of Illness / Costs and Cost Analysis / Delivery of Health Care - economics / Delivery of Health Care - organization & administration / Dengue fever / Diabetes / Disease / Expenditures / Female / Girls / Government spending / Health care / Health care access / Health care policy / Health Care Reform - economics / Health Care Reform - organization & administration / Health Expenditures / Health facilities / Health Information Systems - organization & administration / Health Information Systems - standards / Health Manpower - standards / Health Manpower - statistics & numerical data / Health Status Disparities / Healthcare Disparities / Healthy People Programs - economics / Healthy People Programs - organization & administration / Humans / India / Indicators / Infant mortality / Insurance, Health / Internal Medicine / Life Expectancy / Literacy / Low income groups / Male / Primary care / Primary Health Care - organization & administration / Primary Health Care - standards / Private Sector - economics / Private Sector - organization & administration / Public health / Public Sector - economics / Public Sector - organization & administration / Quality of Health Care / Residence Characteristics / Rural Health / Rural populations / Sanitation / Sex Distribution / Sex Ratio / Socioeconomic factors / Socioeconomic status / State Medicine - economics / State Medicine - organization & administration / Suicides & suicide attempts / Tuberculosis / Universal Coverage - economics / Universal Coverage - organization & administration / Urban areas / Urban Health / Urban populations