As India marked Universal Health Coverage (UHC) Day on December 12, a critical debate has resurfaced: is providing health insurance enough, or does the nation need a more fundamental shift towards genuine universal healthcare? Experts argue that the current focus on financial protection through insurance schemes falls short of addressing the core need for a strong, publicly-funded health system.
The Crucial Gap: Coverage vs. Comprehensive Care
This year's UHC Day theme, "Unaffordable health costs? We’re sick of it!", highlights a growing global frustration. However, professors Rama V Baru and Vikash R Keshri emphasize a vital distinction. Universal health coverage often centers on financial risk protection for illnesses. In contrast, universal healthcare encompasses equitable access to comprehensive primary care, including preventive, promotive, curative, rehabilitative, and palliative services.
The right to health, a principle reinforced by the World Health Organisation's 1978 Alma-Ata Declaration, forms the foundation. Yet, the WHO's 2010 World Health Report shifted focus towards financial reform as a pathway to UHC, an agenda later adopted by the UN and the Sustainable Development Goals. In practice, this has led many countries, including India, to prioritize insurance for hospitalization over strengthening primary care infrastructure.
Lessons from East Asia and India's Own Legacy
Evidence shows that insurance schemes alone often lead to significant out-of-pocket expenditure for patients. This happens due to services not covered, inadequate coverage packages, or potential abuse by service providers. The model that works better integrates public health insurance within a well-financed public health system, where robust primary and secondary care act as gatekeepers.
Several East Asian nations like China and South Korea, which adopted UHC via insurance, are now strengthening primary and secondary care to manage ageing populations and chronic diseases. China, facing high costs, decided nearly a decade ago to invest heavily in prevention, early detection, and follow-up care, alongside human resources and population outreach.
India's own Bhore Committee, just before Independence, advocated for universal healthcare and warned against introducing public insurance before a robust primary healthcare system was established. Sadly, chronic underfinancing of primary healthcare has weakened the public sector, increasing reliance on expensive private care. National Sample Survey data confirm this trend pushes poorer households into debt.
The Path Forward for India
Despite initiatives like the National Health Mission (NHM) and insurance schemes such as the Rashtriya Swasthya Bima Yojana (2008) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, systemic weaknesses persist. The Covid-19 pandemic exposed deep inequities in access, underscoring the urgent need to transition from mere coverage to comprehensive care.
The solution lies in increased public investment. A commitment to public spending is crucial for strengthening primary and secondary care levels. A strong public sector can regulate private providers on quality and cost. For India to tackle its multiple health challenges, it must prioritize investment in comprehensive primary healthcare and address social determinants of health, moving decisively towards the goal of true universal healthcare envisioned decades ago.
