http://www.thehindu.com/news/national/article2482623.ece

NEW DELHI, September 24, 2011
Panel for guaranteed health coverage for allAARTI DHAR

It will be offered as National Health Package for all common conditions

Strongly recommending a re-configuration of the entire health system where
the government will have a major role to play, a high level expert group on
Universal Health Coverage (UHC) has proposed making health care an
entitlement to every citizen.

The group suggested that health care be offered as a National Health Package
(NHP) covering all common conditions and high-impact health care
requirements including in-patient and out-patient care free of cost.

Describing general taxation as the most viable option for mobilising
resources to achieve the target of increasing public spending on health and
creating mechanisms for private protection, it favoured a surcharge on
salaries or taxable income to pay for the UHC and offer cashless health care
to all sections.

According to the panel, the health care services would be made available
through the public sector and contracted-in private facilities (including
the non-government organisations and non-profit groups). These service
providers would not be allowed to accept any additional payments from
individuals or through privately purchased insurance policies for non-NHP
services. Private providers opting for inclusion in the universal health
coverage system would be reimbursed at standard rates as per levels of
services offered to the population, and their activities appropriately
regulated and monitored.

Financing the proposed scheme will require public expenditure on health to
be stepped up from around 1.2 per cent of gross domestic product (GDP) now
to 2.5 per cent by 2017 and to 3 per cent of GDP by 2022. “Increased public
expenditures, in our estimate, will lead to a sharp decline in the
proportion of private out-of-pocket spending on health from 73 per cent at
present to 33 per cent by 2022,'' according to the draft report submitted to
the Planning Commission of India
‘NO DISTINCTION'

“We have made no distinction between the poor and the rich as that would
have brought down the quality of health care as the rich or those who make
and implement policies would have no stake in it. On the other hand, the
participation of the rich will be ensured by taxing them to fund the health
coverage,'' K. Srinath Reddy, president of the Public Health Foundation of
India said. Dr. Reddy chairs the expert group that has also suggested
integration of all government-funded insurance schemes with the UHC system;
replacement of all insurance cards by the National Health Entitlement Cards,
and removing conditionalities, specifically two-child norms for maternity or
other benefits, from all health programmes so as not to punish women and
girls for behaviour over which they have little or no control.
USER FEE

The group has also suggested that user fee of all forms be dropped as a
source of government revenue for financing health. While such fee has, in
some instances, helped to a limited extent in deterring consumption of
excessive and unnecessary medical care, they have not proven to be an
effective source of resource mobilisation.

Drawing attention to inequities in resources among the States, the expert
group has suggested introduction of specific purpose transfers to equalise
the levels of per capita public spending on health across different States
as a way to offset the general impediments to resource mobilisation and to
ensure that all citizens have an entitlement to the same level of essential
health care.

Also, it has said that the Centre should adopt a fiscal transfer mechanism
that allows for flexible and differential financing to States to help meet
the diverse requirements of the States.

Calling for ensuring availability of free essential medicines by increasing
public spending on drug procurement, the report pointed out that low public
spending on drugs and non-availability of free medicines in government
health care facilities are major factors discouraging people from accessing
public sector health facilities.

The group wanted the Ministry of Health and Family Welfare to be
strengthened by bringing the drugs and pharmaceutical companies under its
purview that would in turn strengthen the drug regulatory system.

Envisaging a major role for primary health care in the UHC system, the
report has suggested earmarking at least 70 per cent of public expenditures,
both in the short run and over the medium term, for preventive, promotive
and primary health care. The district hospitals would be strengthened to
take care of the major disease burden.

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Peace Is Doable

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