Health Policy and Legislation

This paper proposes an approach to periodically measure the extent of progress towards universal health coverage using a set of indicators that captures the essence of the factors to be considered in moving towards universalisation. It presents the rationale for the approach and demonstrates its use, based on a primary household survey carried out at the district level. Discussing the strengths and limitations of the approach, it points to how these measures could be further refined. The effort is to find a method of measurement that will apply to any of the alternative ways of progressing towards universal health coverage, however defined and implemented.

Evaluating the effectiveness of the "targeting" approach in the Rashtriya Swasthya Bima Yojana, the present study examines the determinants of enrolment, hospitalisation and financial protection for below the poverty line households using data from a large-scale survey conducted in Maharashtra in 2012-13. Almost 50% of BPL households were found to be non-poor and only 30% of them were aware about RSBY. More importantly, the effect of RSBY on catastrophic health expenditure was not found to be statistically significant. Since commercial insurance companies and their third party administrators have limited interest in awareness generation and enrolment, their role may be reviewed and instead an independent public agency should be given responsibility for enrolment of unorganised sector workers. This would be a key step towards achieving universal population coverage. However, in the long run, the government should strengthen the resource-starved public health system.

Any discussion on universal health coverage in India is premature without a comprehensive understanding of public financing of health coverage in the country. This article analyses the government's share of financial resources for health across different agents, with particular focus on resources for health coverage. An attempt is made to separate spending for health in general and health coverage in particular, and to examine the issue of equity. The analysis indicates that the present health coverage system is inadequate and iniquitous, with various systems running at different costs. It suggests consolidating finances and moving towards a more unified system to realise the benefits of efficiency gains.

For India to improve the existing government health system is far less complex than expanding health insurance. International experience shows the difficulties of regulating an insurance-based system to keep costs down and assure quality.

Chhattisgarh's public distribution system reforms have been lauded as a model for the National Food Security Act, and as one that other states can emulate. Previous research has shown that PDS rice consumption increased in Chhattisgarh following reforms by the Raman Singh government, which began in 2004. However, one-third of PDS rice consumption growth in Chhattisgarh took place before 2004. This finding suggests that the pre-2004 reforms to fair price shop ownership and state procurement by the Ajit Jogi government contributed to PDS consumption growth. Our findings suggest that sustained reforms, when coupled with political and social will, can improve PDS access, and that improvements may not be substantial or sustained in the absence of these factors.