Aspiring for Universal Health Coverage through Private Care

The healthcare system in India is remarkably privatised with stagnating healthcare expenditure over the past few decades. The poor and vulnerable groups have limited access to it. The third National Health Policy (NHP) 2017 assures progressive universal health coverage (UHC) with general taxation as one of the main elements to finance care. It assures free comprehensive primary care through “Health and Wellness Centres,” and reorientation of the public sector hospitals with free drugs and diagnostics with an overall emphasis on a larger role for the private sector in provisioning. It also recognises the need for retaining doctors in remote areas, disease surveillance and integrating health system information. Even though the focus of this policy is to improve health system performance, it opts to go slow in achieving the targets of infant mortality ratio (IMR) and under-five mortality compared to other South Asian countries.

This policy departs from the two previous health policies in terms of the ways it envisages the financing and purchase of healthcare services. It advocates purchaser–provider split (PPS) through contractual relationship. The framework of the NHP 2017 needs to be understood in the context of two World Health Reports (WHR) of 2000 and 2010. WHR 2000 recommended strategic purchasing as means to improve health system performance. Strategic purchasing will entail active decisions as to what healthcare services will be bought, how, and from whom. The main tools for purchasing services are contracting and prepaid schemes. The WHR 2010 pointed out that to achieve UHC, besides increasing health budget and reducing financial barriers, how services are purchased is important, as it links health financing and quality of service. The rationale behind this PPS model is to increase efficiency of the services purchased utilising market mechanisms of competition or collaboration among different providers.