Universal wellness attention – sometimes referred to as cosmopolitan wellness coverage, cosmopolitan coverage, cosmopolitan attention or societal wellness protection – normally refers to a wellness attention system which provides wellness attention and fiscal protection to all its citizens[ 1 ]. The concerns are who is covered, what is covered and how much of the cost is covered. The chief subjects are therefore handiness, population coverage, bundle, entitlement rights and protection against socioeconomic effects of disease.
Typically states have adopted UHC through ( 1 ) enforcing a legal authorization and ( 2 ) insurance coverage, immunisation and attended births. However, we need to understand that cosmopolitan wellness coverage is non same as cosmopolitan health care. While the latter means a system of health care which can take attention of all sorts of diseases and maladies, the former refers to a system where everybody is covered under such health care installations.
There are assorted facets of the Universal Health Coverage and each portion needs great deliberation and research. However, in our undertaking we have chiefly focussed on the funding facets of UHC and we have proposed some theoretical accounts to this terminal. Other of import facets like execution, bringing and operational issues are non covered in item in this undertaking.
India & A ; Universal Health Care
The instance of India is peculiar in the sense that wellness coverage entirely may non sufficient as in many topographic points there are no installations for supplying even the basic health care services. So, what India needs is non merely a cosmopolitan wellness coverage, but besides a cosmopolitan health care.
India ‘s bedraggled wellness substructure with less than 2 physicians per 10k rural population and less than 1 hospital bed per 1000 population indicates the misery of India ‘s health care. Even the Health Ministry in the Cardinal Government is non a strong place in cabinet taking to low public disbursement in health care.
78 % of healthcare outgo is Out-of-pocket payment in India and merely a small letter sum of GDP is spent on public wellness disbursement.
Role of Community Health Insurance in heightening UHC in India
India has done commendably good in implementing community based wellness insurance which was able to cover a big part of the underprivileged population. Insurance strategies like RSBY, Yashaswini, Vajpayee Arogyashree, SEWA etc. have helped to supply forte health care even to the BPL population. At present about 30 % of the Indian population is holding some sort of wellness insurance and the bulk of this is through community insurance. Hence, these community-based group insurance strategies have helped India towards accomplishing greater UHC.
How was UHC Achieved in Other Countries in the Past?
Most states achieved UHC in low and in-between income phases of development by following a legal committedness to cosmopolitan coverage. The legal committedness was supplemented by policies to set up a comprehensive system ( substructure and manpower development ) and largely public funding was used to prolong the UHC authorization.
Lessons for India
India needs to follow a legal committedness fast, as without the legal committedness a big proportion of population would be left vulnerable for drawn-out periods of clip. Besides, it is seen that proliferation of coverage is really slow without a proper legal authorization. Trusting entirely on the private participants for UHC is hazardous as they may take to disproportionate benefits a section of population without covering the truly destitute 1s. Sing all these, a public funding system for UHC is better and just as it would be more pro-poor who can non otherwise afford the health care.
India ‘s Position in Healthcare
India has a distinctive feature in this regard as it has moved to the “ first universe ” jobs even before work outing the old jobs. Besides, there is a immense disparity among provinces. E.g. the IMR ( Infant Mortality Rate ) varies from 72 in MP to 13 in Kerala per 1000 people. Furthermore, there are multiple divisions in Indian society with Urban-Rural, Income, Education, Gender, Caste and so on.
Reach, Accessibility and Affordability[ 2 ]
There is a immense disparity in India with respects to these prosodies. These are apparent in the undermentioned few statistics:
18 % of all episodes in rural and 10 % in urban countries received no health care at all
12 % in rural countries and 1 % in urban countries had no entree to any wellness installation
28 % of rural occupants and 20 % of urban occupants had no financess for wellness attention
40 % of hospitalized individuals had to sell assets or borrow money to afford intervention
35 % of hospitalized individuals fell below poorness line due to hospital measures
Strong Urban-Rural divides with 80 % physicians, 75 % dispensaries and 60 % infirmaries in urban countries. No. of qualified physicians in urban countries is 11.3 vs. 1.9 in rural countries per 10,000 people.
Financing National Health Care System
In wide footings, there are two ways in which a wellness attention system can be financed, viz. insurance and revenue enhancement. Following are the farther bifurcations of these options:
Private Insurance: Insurance contracts where persons voluntarily pay premiums out of their ain pockets to avail a hazard screen against wellness jobs and cost spending associated with it. The insurance supplier in this instance would be a “ for net income ” organisation though there exists public companies of “ non for net income ” organisations supplying wellness insurance in many states.
Typically, the insurance premium under private insurance depends on the hazard profile of the person. Further, there may be deductible parts, co-payments or user charges so the damages may non be 100 % .
Social Insurance: This theoretical account of insurance works more like the new pension strategy introduced by the Indian authorities recently. The authorities sets up a fund where people, organisations and/or authorities contributes a certain amount of money. Size of part can be determined by income degrees and business. Contributions may non be collected below a certain income degree. Persons so can entree the insurance installation as the demand arises.
The parts in such a strategy are non linked to the hazard profile but are dependent on income levels/paying capacity of an person. So we can state that this theoretical account works on the construct of caring outwardnesss.
General Tax: this basically means that the revenue enhancement is levied merely like any other revenue enhancement without stipulating the intent of it. It goes to the overall caisson of the authorities and so a portion is allocated towards wellness attention.
Hypothecated ( Earmarked ) Tax: When the revenue enhancement levy is earmarked for a peculiar intent, it is called hypothecated revenue enhancement. For illustration, the instruction Ce in India is a hypothecated revenue enhancement. Such levy for health care is another option for funding the wellness attention system.
Why Insurance would non work in India
The planning committee ‘s commission on UHC flatly takes a base against an insurance based funding strategy for UHC. Primary grounds are as follows:
It fragments health care
Does non supply full coverage of needed services ( deductibles )
Fails to cover whole population
Required TPA coverage, jobs of handiness
Private insurance option can be ignored given the affordability restraint of bulk of hapless population in India. Then, the insurance incursion itself is non all permeant to accomplish a cosmopolitan insurance coverage. For net income motivation will besides impede the chase of low-cost cosmopolitan coverage.
Though India has had a good experience with a figure of societal wellness insurance strategies, it still might non be plenty to represent a cosmopolitan wellness insurance strategy to accomplish UHC. The ground being, that more than the paying capacity, there exists spreads in handiness, entree and quality of attention. The authorities needs resources in manus to guarantee that there exists a wellness system which people can entree in times of demand. These restraints leave us merely with the option of revenue enhancement funded UHC.
Using the revenue enhancement base to finance UHC
The commission recommends increasing pass on health care from current 1.2 % of GDP to 2.5 % by the terminal of 12th 5 twelvemonth program and to 3 % of GDP in the thirteenth program. It goes on to urge an addition in passing on public procurance of indispensable drugs from current 0.1 % of GDP to 0.5 % of GDP.
It recommends usage of general revenue enhancement to fund this addition in disbursement. The chief beginning recommended is via extra compulsory tax write-offs from salaried persons and taxpayers. The commission does non notice on the extent of such tax write-offs and the fund demands to accomplish UHC.
Can Indian revenue enhancement Payer Sustain this?
The revenue enhancement base itself in India is so little that earning UHC support from the taxpayers look like a tall claim. The tabular array below shows the revenue enhancement base of India:
No. of Tax Payers ( in Lacs )
Tax Collected ( Rs. Crores )
0-5 hundred thousand
5-10 hundred thousand
10-20 hundred thousand
& gt ; 20 hundred thousand
There are merely 35.72 Lakh revenue enhancement remunerators who earn more than Rs.5Lakh a twelvemonth. The sort of revenue enhancement gross authorities would necessitate to bring forth to fund UHC can ne’er be achieved from taxing these persons. A little computation below would demo the unviability of the proposition:
Nominal GDP per capita
Proposed addition in wellness disbursement
1.3 % of GDP
Monetary value of the addition
GDP per capita ten population x 1.3 %
Monetary Value ( in Crore Rs. )
As the computation shows, the pecuniary value of the proposed addition in disbursement is Rs.1,27,063Crore rupees whereas the entire revenue enhancement base of India is merely Rs.1,48,000Crore. It translates into a revenue enhancement of Rs.3.55Lakh on every revenue enhancement remunerator gaining more than Rs.5Lakh a twelvemonth. There is no manner the authorities can accomplish such addition in revenue enhancement aggregation merely by increasing revenue enhancement rates or enforcing tax write-offs or levies.
Is there a range for broadening revenue enhancement base?
Income revenue enhancement ( or any other revenue enhancement for that affair ) is a distortionary signifier of revenue enhancement which affects the comparative monetary values and leaves the revenue enhancement remunerator worse off. Traveling by the public assistance economics basicss it is ne’er a good thought to increase revenue enhancement to fund public assistance strategies such as UHC.
As the literature suggests ; merely signifier of revenue enhancement that is non distortionary, is some kind of “ per caput ” revenue enhancement that leaves everyone every bit worse off. There is no known mechanism to enforce such revenue enhancement as the construct itself may be absurd. Furthermore, everyone can non be taxed in a state like India where poorness is prevailing. The option can be to place certain groups in the population where a revenue enhancement can be imposed footing the assets people hold and non linked to the income degrees. Since plus base can be an index of wealth, this revenue enhancement may non be termed unjust as poorest of the hapless will non be taxed.
Health Insurance provided by the employers: is there a lesson to larn?
We propose this thought from our side for UHC funding. It is merely a hypothesis that needs proving on several foreparts but may function as a footing for bring forthing advanced thoughts for earning financess for UHC. Since it is common for the employers in organized sector to pay for the wellness insurance of their employees, we can look at the possibility of doing the employers in the unorganised sector wage for the wellness coverage of their employees.
There are household aid workers, contract labourers, drivers of coachs, trucks and taxis, husbandmans and rural labourers that constitute the unorganised sector in general. Furthermore, these are the sectors which are least likely to hold any sort of wellness screen. We have this thought of placing the employers of these people and do a system to roll up part from these possible employers towards wellness coverage of these employees/workers.
We have kept in head the fact that aggregation of such parts can be a dearly-won and complicated matter so we have kept our suggestions such that there will be no extra apparatus required to roll up these parts. We have linked all aggregations to bing aggregation mechanisms in topographic point.
Below is the wide lineation of our attack towards the job:
The sections of unorganised sector workers targeted are domestic workers, rural unorganised sector workers, urban workers and agricultural labourers.
We have used the placeholders such as plus base ( a decent pucca house with 2 suites in urban countries for employers of domestic aid, for illustration ) to place the employers and have proposed a revenue enhancement on those employers in signifier of little levies linked to their bing compulsory payments such as motor insurance or public-service corporation measure payments.
In rural scenes, we have targeted the bing public assistance strategies and since the employer is the authorities over at that place, we recommend a part from the authorities ‘s side to supply a wellness screen to these workers.
The major strategies are the Kisaan Credit Card for husbandmans from public Bankss and NREGS for non-agricultural workers.
We have assumed that a cost of Rs.600 will be sufficient to supply a basic wellness screen to a typical household of these workers. The sum of Rs.600 is based on mean premium under RSBY where a screen of Rs.30,000 is provided against secondary attention.
Below are the inside informations of each of the section.
Proposed UHC Financing Frameworks in Unorganised Sector
For financing the Universal Health Coverage costs we have proposed a few theoretical accounts. The theoretical accounts basically focus on imposing a non-distortionary revenue enhancement ( or something near to a non-distortionary revenue enhancement ) and thereby convey everyone under the scope of healthcare coverage. These are described below:
The domestic aid in the families are largely uncovered by any sort of wellness insurance and many of the times they are really vulnerable to ruinous health care outgos. In our undertaking, we propose to cover this hitherto uncovered section by roll uping a part from their employers. This would be a broad-based revenue enhancement for all families holding a motor vehicle and more than 2 room apartments/houses. We call this part of population the “ comparatively privileged ” . Our theoretical account therefore would extinguish the operational challenge of placing which family has domestic worker and which does non. The dealing costs in roll uping the sum can be avoided by integrating a aggregation mechanism along with regular house revenue enhancements or public-service corporation measures. The coverage potency for this proposed theoretical account is shown below:
The computation shows that the sum would be plenty to fund a Rs.600 per annum program for about 21 million households.
Rural Unorganized Sector Workers:
For rural sector population since the NREGA strategy is already in topographic point we propose to utilize this for financing the UHC. We propose that the authorities should lend extra 4-5 % on each job-card upfront for financing the health care. The sum collected can be used to fund the health care for 41.6 million households.
However, the issue to fairness in subtracting from the already minuscular sum of NREGS wage can be debated. But we thought that since anyhow the households would be passing a part of their wage for health care ( sometimes it can even be ruinous ) , it should be sensible to subtract ~5 % upfront and thereby avoid ruinous wellness outgos. For operational portion, since all NREGS rewards are paid through bank histories, this proposal can implemented without any extra apparatus.
Urban Unorganized Sector Workers:
For funding the urban unorganised sector workers, multiple options were considered. In urban countries big figure of registered motor vehicles provides an first-class chance for financing the UHC. Besides, since all the motor vehicles emit fouling gases to the environment and this adversely affects the wellness of the people, enforcing a levy on the vehicles can be considered just. In fact, this levy would be a placeholder for the monetary value the vehicles proprietors are paying for the pollution they generate. Furthermore, having a vehicle may be considered as a mark of prosperity and a comparatively comfortable individual should non mind in lending a small for the society ‘s improvement.
Here, we have proposed a double levy, one during new enrollment and the other a annual charge. The aggregation can be done by clubbing with new enrollment charges or annual insurance premium which is anyhow compulsory for all motor vehicles.
For including the agricultural workers we propose to utilize the already bing agricultural recognition theoretical accounts like the Kisan Credit Cards ( KCC ) . As portion of fiscal inclusion program harvest loans are disbursed through KCC at a concessional rate of 6-7 % .
We propose a 1 % tax write-off from such loans towards part to UHC funding. The gathered sum would be used to finance the health care costs of the agricultural families. The Bankss already obtain a life insurance screen on all the borrowers. An extra wellness screen will non merely guarantee UHC but besides serve as a prudent recognition direction step for the Bankss. Government needs to the portion the cost of such part to guarantee the fringy husbandmans are non adversely affected.
Since KCC loans are disbursed through Bankss, no extra apparatus is required to roll up this part sum, as they can be collected upfront at the clip of loan expense.
Other Ways and Methods
There are many other sections of the population non covered in the above theoretical accounts. Some of the methods that can be adopted for these sections are given below:
It is to be ensured by ordinances that the contract workers have equal wellness coverage ; contractors should use them merely after guaranting such coverage.
The store proprietors should lend for their employer ‘s wellness coverage. This can be paid along with public-service corporation measures or belongings revenue enhancements.
Undertaking clearance for building etc. should merely be given after guaranting that the employees/workers/casual laborers have equal wellness coverage.
However, we do non hold accurate Numberss to cipher the coverage potency through these methods. But we see that even without sing these, we are able to roll up adequate sum to finance wellness coverage for 91.5 Crore persons though merely by utilizing arbitrary premises non really scientific. Though the contributory sum considered is an arbitrary premise in our theoretical account, we see that there is possible to broaden the revenue enhancement base and to aim certain sets of populations via authorities parts. Even the sum of Rs.600 per household is minuscule and coverage like RSBY may non even be sufficient to be called UHC, we clearly see a possible to earn fundss for the betterment of wellness system via such steps.
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