India Needs Universal Health Insurance, Not Universal Healthcare
Universal Health Coverage (UHC) ensures everyone has access to needed quality health services without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care.
In India, it means providing access to quality healthcare services, including prevention, treatment, and rehabilitation, without causing financial hardship for all.
One of the important agendas of universal health coverage is to ensure the reach and coverage of the most marginalised population. Three things are shared by nations that have successfully implemented free universal healthcare through taxation.
The country with the largest population in the world, India, has a tax-to-GDP ratio of 11.70% and spends 3.16% of its GDP on healthcare. Out-of-pocket medical expenses account for 1.52% of GDP, with the government contributing 1.28%.**
Thankfully, the Ayushman Bharat programme provides coverage for people who are below the poverty line.* What about the millions of Indians who are just one medical expense from becoming hungry?
300 million middle-class Indians will be able to afford health insurance even when they cannot afford to pay for hospitalization. Rather than “universal healthcare,” focusing on “universal health insurance” will help with integrated coverage for primary, secondary, and tertiary care.
Why is primary care so crucial? About 30% of Indians schedule at least two annual visits with their primary care doctors. Hospitals can easily regulate uncontrolled diabetes and blood pressure that cause heart attacks, brain strokes, and kidney failures online. The majority of diseases can be treated with early identification.
What integrated family health insurance approach would be best? The aim is to create an integrated health insurance model, with an annual premium ranging from Rs 8,000 to 10,000 for a family comprising parents and children under 21, through iterative development. By paying a nominal fee of Rs 1,000, parents should get health exams that cost roughly Rs 15,000. Early detection relies heavily on health screening. One should compare health insurance before buying it.
Families should have coverage for single admissions up to Rs. 50 lakh, multiple admissions up to Rs. 10 lakhs, and unrestricted outpatient coverage, including costly procedures like transplants and artificial heart surgery.
If every farmer in Karnataka paid Rs 5 a month, they could receive coverage for any treatment at more than 700 facilities, including procedures for cataracts and the heart. Through cooperative societies, the state government started the programme, joined as a reinsurer, and the rest is history. After 12 years, 1.21 million farmers underwent surgeries, and 1.3 lakhs received heart procedures, all for the low cost of Rs 5 per month.
^Claims are subject to terms and conditions set forth under general health insurance policy.
Advocating for universal health insurance, rather than universal healthcare, is a compelling approach for India’s healthcare system. Universal health insurance can offer comprehensive coverage, including prevention, treatment, and financial protection. This ensures that all citizens have access to quality healthcare services without facing excessive financial burdens. It acknowledges the importance of affordable and accessible health coverage as a means to improve healthcare outcomes and protect individuals from economic hardship.
*Standard T&C Apply
**Tax benefit is subject to change in prevalent tax laws
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