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Towards Universal Health Coverage? Taking Stock of Two Decades of Health Reforms in India

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India’s Economy and Society

Part of the book series: India Studies in Business and Economics ((ISBE))

Abstract

As part of the 2030 Agenda for Sustainable Development, all countries, including India, have committed to trying to achieve univeral health coverage (UHC) by 2030. There are three dimensions to UHC: population coverage, services coverage, and financial risk protection. The goal is to make available to 100% of the population a broad-enough range of essential health services that cover 100% of their healthcare needs and ensure that 100% of the population can receive these services without incurring health expenditure that is more than 10% of the monthly household expenditure. While UHC is a desirable goal, it poses significant challenges for low- and middle-income countries on many fronts. Over the past two decades, India has implemented a wide range of reforms in the health sector ostensibly towards making healthcare services accessible to all. This paper discusses major health financing reforms and private sector engagement in health in India from the perspective of their contribution to UHC. Based on the existing evidence, the paper argues that recent health reforms in India have made limited contributions to access with financial risk protection for socially and economically marginalised groups. Inequalities in coverage by health services have been accentuated and the less privileged bear a disproportionate burden of catastrophic health expenditures. Drawing on the experiences of LMICs in Asia, such as Thailand and Vietnam that have achieved near-universal health coverage, the paper concludes with listing much-needed reforms that are urgently needed for India to move anywhere close to UHC.

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Notes

  1. 1.

    Comparable data on service coverage by the state are only available for RMNCH indicators and are included here.

  2. 2.

    In the states of Andhra Pradesh, Karnataka, Maharashtra, Orissa, Punjab, Tamil Nadu, Uttar Pradesh

  3. 3.

    These included antenatal care use, content of antenatal care, knowledge and preparedness for pregnancy and birth, use of delivery care, adoption of recommended delivery-care practices, reduction in harmful or ineffective delivery-care practices and over-used practices, respectful care, financial consequences, post-partum care, content of newborn care, neonatal health, breastfeeding, and family planning.

  4. 4.

    The description of Thailand’s UHCReforms is based on a presentation by Viroj Tangcharoensathien in a seminar in Trivandrum, on 9 September 2018.

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Authors and Affiliations

  1. United Nations University—International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia

    T. K. Sundari Ravindran

  2. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

    T. K. Sundari Ravindran

  3. Department of Epidemiology and Public Health, Central University of Tamil Nadu, Nilakkudi, India

    Neena Elezebeth Philip

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  1. T. K. Sundari Ravindran
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  1. Centre for Development Studies, Trivandrum, India

    Sunil Mani

  2. Centre for Development Studies, Trivandrum, India

    Chidambaran G. Iyer

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Ravindran, T.K.S., Philip, N.E. (2021). Towards Universal Health Coverage? Taking Stock of Two Decades of Health Reforms in India. In: Mani, S., Iyer, C.G. (eds) India’s Economy and Society. India Studies in Business and Economics. Springer, Singapore. https://doi.org/10.1007/978-981-16-0869-8_10

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