challenge of universal health coverage
A universal health coverage plan in India must be developed considering the very different realities in each State
universal health coverage (UHC)
A UHC plan for States must be developed considering these very different realities
Government expenditure (per capita) on healthcare
for example, varies significantly from State to State. Himachal Pradesh, Kerala, and Tamil Nadu spend ₹3,829, ₹2,590, and ₹2,039, respectively, while Uttar Pradesh and Bihar spend only ₹951 and ₹701, respectively (National Health Accounts — Estimates for India 2019-20).
highest teenage pregnancy rates
West Bengal, a predominantly rural State, has a low fertility rate at 1.64, but it also has one of the highest teenage pregnancy rates (16%).
This is very different from other States with low fertility, such as Kerala and Himachal Pradesh, where teenage pregnancy rates are 2.4% and 3.4%, respectively (National Family Health Survey-5, 2019-2021). .
Not the solution
Government health expenditure in West Bengal
which was ₹1,346 per capita in 2019-20, is only about 61% of the estimated ₹2,205 (research-based and inflation-adjusted) required to offer UHC.
Madhya Pradesh
This number compares with a similarly populated State such as Madhya Pradesh where government health expenditure is ₹1,249 per capita.
Growing government health expenditure is good but may not solve the problem
West Bengal’s government health expenditure
has been growing at 11% per annum over the last few years and, at this rate, could grow to fully meet the funds estimated to be required for UHC by 2030.
However, the State’s out-of-pocket expenditure was high at 67% in 2019-20 and had only reduced by 2-3% from the previous years (National Health Accounts — Estimates for India 2019-20).
The story is no different in Andhra Pradesh
which saw a 3% increase in per capita government health expenditure in 2019-20 from the previous years,
but had a high out-of-pocket expenditure of 64% (National Health Accounts — Estimates for India 2019-20).
Deeper challenges
Thus, increasing government health expenditure does not appear to be working to contain a key issue relating to the health burden on citizens. This suggests that there are deeper design challenges with the health system. Without addressing these, increased government expenditure on health may do little to reduce out-of-pocket expenditure rates.
The implications of this are significant. Out-of-pocket expenditure already accounts for a majority of health spending in most of the States. A paper published recently (Sangar et al. 2018) noted that out-of-pocket expenditure accounted for more than 50% of health spending not just in poor States such as Jharkhand, Bihar, and Uttar Pradesh, but also in comparatively prosperous States such as Kerala and Punjab, which have strong healthcare systems.
In the case of West Bengal, high C-section rates even within the public sector strongly indicate that there is an adequate supply of public sector hospitals at which free care can be offered. This negates the need and relevance of the State’s Swasthya Sathi scheme, which is intended to allow patients to seek care in private hospitals using the government’s limited tax resources. It is designed to compensate for a deficiency in the supply of government hospitals.
On the other hand, that there is a significant share of adults with high blood sugar rates across West Bengal, relative to the rest of the country; and also relatively low rates of hypertension in the State suggests high rates of genetically inherited insulin insufficiency, which needs to be addressed with urgency in primary care settings. Similar trends are observed in Bihar and Gujarat, which also have high blood sugar levels and relatively lower hypertension rates, in contrast to Kerala, Tamil Nadu, and Telangana, where both conditions are prevalent. This necessitates tailored health system strategies and region-specific public health messaging to address the varying trends in non-communicable diseases across different areas.
Data also show that while there is an income gradient, even the very poor in West Bengal have high blood sugar rates. It is clear from the high blood sugar rates that the current, largely out-of-pocket expenditure-driven health system design cannot address this challenge and that a much more proactive approach needs to be taken at the primary care level. However, with a 58% shortfall in primary health centres and health and wellness centres, the primary healthcare system in the State faces challenges in meeting the healthcare needs of its population; this needs to be addressed urgently.
A mosaic of challenges
The data here illustrate how healthcare is an interconnected system that presents a complex mosaic of challenges and opportunities. These cannot be addressed by blanket solutions that are unmindful of the uniqueness of the local area health profile, and its deeper relations to history, culture, and ways of working. Thus, leverage points vary and blunt instruments or even throwing resources can have little impact and, in some cases, make the situation worse. A holistic approach is essential, integrating public health initiatives, regional policy adaptations, and climate resilience, to build a robust and equitable healthcare system.
Comments
Post a Comment