Universal Health Coverage Policy and Practice Framework in India: A Review

Challenges to Achieving Universal Health Coverage Throughout the World: A Systematic Review

“…These include gaps in fundamental business practices (human resources, finance, and procurement). In addition, other challenges, shown in Figure 3 , include an absence of managerial feedback loops, in part due to limited supervision and empowerment at healthcare facilities [ 15 – 25 ]; public health challenges such as demographic shifts, epidemiological changes, low equity, and low gross domestic product [ 15 , 19 , 23 , 26 , 27 ]; the liberalization of global trade and the corresponding increased burden of disease resulting in a higher demand for healthcare services [ 28 ]; the absence of integrated clinical and frontline health worker data and suboptimal health information systems, as well as the limited use of existing data [ 21 , 23 , 29 ]; the need to design benefit packages and prioritize certain health needs across 3 dimensions, which include coverage population, service, and cost [ 13 , 26 ]; inefficiencies in the management of insurance schemes [ 4 , 17 ]; insufficient government finances [ 5 , 18 ]; a lack of support from key stakeholders [ 4 ], and low trust in public healthcare facilities [ 21 ].…”

“…The main challenges related to UHC concerning creating resource are inadequate human resources and health workers [ 1 , 3 , 5 , 18 – 21 , 23 , 25 ]; challenges related to the production, performance, and distribution of health workers [ 5 , 25 ]; inadequate medical facilities for public hospitals and community health centers [ 25 , 29 ]; inadequate health infrastructure [ 4 , 20 ]; a shortage of technology, equipment, and materials [ 20 ]; inequity in the allocation of public health resources (both financial and human) [ 30 ]; and “supply-side readiness,” which refers to the availability and quality of services [ 13 ]. Figure 4 summarizes these challenges.…”

“…The main challenges of pooling, the second sub-category, are the lack of health insurance coverage for people and services [ 4 , 5 , 27 , 29 , 32 ], existing systems of voluntary health insurance [ 28 ], fragmentation of the pool of health insurance funds [ 4 , 27 , 34 ], the lack of financial support or protection [ 1 , 5 , 17 , 23 , 30 , 32 , 35 ], the high proportion of out-of-pocket spending [ 30 , 31 , 35 ], a large proportion of people who live in extreme poverty who are unable to pay premiums [ 4 , 32 ], the high cost of transportation to reach healthcare facilities for people with disabilities, and disproportionate copayments for physical therapy, laboratory tests, and some medicines [ 32 ].…”

“…The main challenges of the third sub-category, purchasing, are confusion about the conditions needed to receive reimbursement for health expenses [ 32 ]; the small share of resources allocated to low-level health facilities and community-based services [ 16 , 25 ]; the complex interplay between inadequate allocation, unequal distribution, and inefficient utilization of funds allocated to public health measures [ 33 , 35 ]; low investment in health and primary healthcare [ 21 ]; cost control [ 18 ]; and the unequal allocation of financial resources for public health [ 23 , 30 ].…”

“…The main challenges related to UHC concerning delivering services, as shown in Figure 5 , are unregulated and fragmented healthcare delivery systems [ 16 , 19 , 22 , 23 , 25 ]; inadequate care and services in terms of quality [ 1 , 29 , 33 ]; the aging of the population, which increases the risk of geriatric health issues [ 23 , 27 , 35 ]; the increasing burden of non-communicable diseases, persisting infectious diseases, and the reemergence of infectious diseases with pandemic potential [ 3 , 19 , 23 , 25 ]; increasing unmet health needs [ 15 , 24 ]; the rapid privatization of healthcare services leading to increased treatment costs [ 35 ]; failures to expand and strengthen services [ 20 , 25 ]; incorrect diagnosis of the highest-priority demands [ 20 ]; the expansion of health coverage in formal and informal sectors [ 5 , 13 ]; and significant healthcare inequity [ 17 , 23 , 25 ].…”