Universal healthcare (UHC) is an important global goal because of its close links to poverty reduction and enhancement of the growth potential of countries. While several countries can now be said to be well on their way towards achieving this goal, several others, most notably large ones such as India and Nigeria, are decidedly not.
Though there are a number of reasons for this, perhaps the most important one has been the position taken by the international development community that an essential prerequisite for beginning work on UHC is government financing of all health expenditures through taxes.
This position is untenable, because these governments (including Indian central and state governments), prefer to spend on other development priorities. They also have a low tax base, as a high proportion of the working-age population is employed in the informal sector.
As a result, these governments have, for decades, either been unable or unwilling to provide the necessary financial resources for UHC. This has meant that not only has there been no progress on UHC, but there has perhaps even been a regression away from it.
A direct consequence of this rigid global position is that scant attention has been paid to the actual expenditures on healthcare by the populations of these countries, and that despite the fact that residents of these countries spend large amounts on healthcare, they continue to experience very poor health outcomes.
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For instance, in India, seventy percent of healthcare expenses are met by out-of-pocket expenditure—an amount that could ensure high-quality care for everyone. Instead, one sees a proliferation of low-quality and informal primary care and several small- to medium-sized formal sector players, and the inability of most of the population to access high-end tertiary care even when needed.
Given these realities, it becomes important—now more than ever—to find a way forward that is not only feasible, but also one that can benefit from increased government allocations to health whenever they become available, without being held hostage to it.
There are many different pathways to achieving this, and this article proposes one that could have the potential to add value to citizens in the short-run, even if it does not immediately address all of the underlying issues, such as high out-of-pocket expenditures.
In the longer-run, such an approach could gradually move the entire health system, in a dynamic way, closer towards the classical UHC end-state of 100 percent financial protection, 100 percent population coverage, for 100 percent of patient conditions. Some of the key stepping-stones comprising this pathway include:
1. Begin with primary care and ensure that people get more value from their current out-of-pocket expenditures
This can be done by using a careful process of vetting and organically growing the current mass of thousands of independent primary care facilities into a high-quality primary health care network. While consumers will continue to pay for it on an out-of-pocket basis, it will deliver good value and strong health outcomes to them in exchange for these expenditures.
At the end of this journey, these primary care providers would not offer only walk-in services. Instead, they would seek to enrol a defined set of individuals; offer every enrolled individual a comprehensive set of highly protocolised primary care services; identify at-risk individuals from amongst these and proactively seek to bring their risk levels down; coordinate higher levels of care should any member require more advanced care; and take responsibility for all the public health functions for their members.
Source: Inter Press Service
