Horses for Courses: Moving India towards Universal Health Coverage through Targeted Policy Design

Abstract

The debate on how India's health system should move towards universal health coverage was (meant to be) put to rest by the recent National Health Policy 2017. However, the new policy is silent about tackling bottlenecks mentioned in the said policy proposal. It aims to provide universal access to free primary care by strengthening the public system, and to secondary and tertiary care through strategic purchasing from the private sector, to overcome deficiencies in public provisioning in the short run. Yet, in doing so, it ignores critical factors needed to replicate successful models of public healthcare delivery from certain states that it hopes to emulate. The policy also overestimates the capacity of the public sector and downplays the challenges observed in purchasing secondary care. Drawing from literature in policy design, we emphasize that primary, secondary and tertiary care have distinct characteristics, and their provision requires separate approaches or policy tools depending on the context. Public provisioning, contract purchasing and insurance mechanisms are different policy tools that have to be matched with the context and characteristics of the policy arena. Given the current challenges of India's health system, we argue that tertiary care services are most suitable for insurance-based purchasing, while the public sector should concentrate on building the required capacities to dominate the provisioning of secondary care and fill gaps in primary care delivery, for India to achieve its universal coverage ambitions.

Participation of delivering private hospital services in universal health coverage: A systematic scoping review of the developing countries' evidence

“…Coverage of 12% of the overall geographical context by India[ 17 44 45 46 ] might indicate that as this country has almost a fifth of the world's population, naturally, a high number of records arise from very diverse health needs based on its cultural, socio-economic, and ethnic diversity. [ 44 ] Despite the high frequency in India, a large number of codes in response to research questions regarding population, and concept, came up from Mongolia, due to its three articles[ 47 48 49 ] that were exactly concerned with the role of PHS in UHC.…”

Notions of policy effectiveness and implications for policy design: insights from public-private partnerships in India

“…In the health sector. These efforts are reflected through policies and programs promoting P3s since the 1990s (Bali and Ramesh 2015;Bhat 2000;Maurya, Virani, and Rajasulochana 2017). These include a variety of arrangements, from the use of private contractors in supportive services, to their engagement in the provision of core medical services.…”

Contracting out: making it work

“…The small size of health insurance business 2 , lack of standardization in various areas of healthcare (such as treatment, records, the billing process, etc.) and slim profit margins had prevented investment in capacity building by ICs (Maurya, Virani, and Rajasulochana 2017). Health insurance was still at an infantile stage, and insurance companies unable to control providers were hesitant to expand operations due to the losses incurred (Bearing Point 2008).…”