Pradhan Mantri Fasal Bima Yojana (PMFBY) is a flagship scheme of the Government of India to provi... more Pradhan Mantri Fasal Bima Yojana (PMFBY) is a flagship scheme of the Government of India to provide insurance coverage and financial support to farmers in the event of failure of any of the notified crops, unsown area and damage to harvest produce as a result of natural calamities, pests and diseases to stabilise the income of farmers, and to encourage them to adopt modern agricultural practices. The scheme is a considerable improvement over all previous insurance schemes in India and is heavily subsidised by the state and central governments. The scheme aims to cover 50 percent of the farming households within next 3 years. During its implementation in the last one season, several challenges relating to enrolment, yield estimation, loss assessment, and claim settlement were reported by farmers, insurance companies as well as the state governments. It was also noted that several technological opportunities existed for possibly leveraging support to the Indian crop insurance program ...
Page 1. IFPRI FOCUS 5 FEBRUARY 2001 INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE • 2033 KSTREET, ... more Page 1. IFPRI FOCUS 5 FEBRUARY 2001 INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE • 2033 KSTREET, NW • WASHINGTON, DC 20006-1002 • USA PHONE: +1-202-862-5600 • FAX : +1-202-467-4439 • EMAIL: [email protected] • WEB: www.ifpri.org ...
Countries with universal or near universal access to healthcare have health financing mechanisms ... more Countries with universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. This contributes to both equity in healthcare as well as to low levels of poverty in these countries. It is only in countries like India and a number of developing countries, which still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast, a large majority of the population, who suffers a hand-to-mouth existence, is forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non existent. Thus, the absence of adequate public health investment not only results in poor health outcomes but it also leads to escalation of poverty. This article critically reviews the linkages of poverty with healthcare financing using evidence from national surveys and concludes that public financing is critical to good access to healthcare for the poor and its inadequacy is closely associated with poverty levels in the country.
NGOs are private organisations, but their nature makes them somewhat different from what one gene... more NGOs are private organisations, but their nature makes them somewhat different from what one generally refers to as the private sector. Firstly, organisations operating as NGOs are registered either as 'trusts' or 'societies'. As a consequence, they are not supposed to make profit, unlike the private sector. Secondly, NGOs are involved in the 'development sector'; that is, running programmes such as health, nutrition, family planning, education, water supply and sanitation, urban renewal, housing, research, training and documentation, agriculture related development programmes (IRDP etc) and employment programmes (FFW etc), among others. These constitute what one might call service-NGOs. Another category of groups included under the banner of NGOs are activist groups who are involved in conscientisation and struggle oriented activities, but they may also undertake some services. Organisations that are usually only production-oriented are normally not included under the NGO umbrella. However, some service NGOs may undertake production activities such as agriculture, household industry, etc. And there are also funding agencies which are referred to as NGOs. Thirdly, NGOs are invariably dependent on external sources of financing for their activities (including most activist groups). And finally, a large number of NGOs, especially in rural areas, ru n programmes of the government on a contractual basis because of their (NGOs) supposed dedication and flexibility. This is a more recent phenomena (Fifth Plan onwards)—the government, for instance, gives its own health centre or IRDP project to be run by an NGO because the government believes that its own structure is inefficient, bureaucratic and incapable of reaching the beneficiaries. In 1953 the government set up the Central Social Welfare Board, to provide grant-in-aid to NGOs. Further, in its own development programmes, the government sought the expertise and cooperation of well-known NGOs. This was more so necessary when CDP was evaluated at the end of the First Five Year Plan by the Planning Commission: "Most of the time was spent in solving procedural/administrative wrangles making implementation of programmes inefficient, inadequate and wrongly directed" (GOI, 1958). The government could not ignore the social services sector and the private sector was unwilling to invest in social infrastructure. The private sector, for its ow n expansio and profitability, pushed the government into investing vast public resources in building infrastructures and heavy industry that was essential for economic growth, but more so to facilitate the growth of private capital. As a consequence, the social sectors like health and education were totally neglected— health sector was mainly operated by private practitioners and a large number of hospitals run by NGOs, and the education sector was mainly run by NGOs (missions, public trusts and societies). The NGOs in these early years were largely concentrated i n urba areas, but many were now gradually spreading their tentacles into the countryside, the leaders being Gandhian and Christian missionaries. In the health sector the government, though i principle ha d accepte the Bhore committee recommendation, was still undecisive—even today, the physical targets recommended by the Bhore committee are far from realisation. The anti-malaria and anti-smallpox campaigns were undertaken at the behest and with support of international agencies. It was not until the mid-sixties (Third Plan) that the health infrastructure for rural India got serious attention from the government. This too for two reasons—the resurgence of malaria and the government's decision to give family planning programmes a big boost through the camp approach. This was also the time when the green revolution in India began and the countryside had suddenly come into focus (from the perspective of mainstream economics). The corporate sector showed increased interest in rural India for here was an opportunity to capture rural markets not only with the new agricultural technology but also (due to increased commercialisation of agriculture) with other goods and services. The corporate sector, however, was unwilling to go on its own into the rural areas. It wanted crutches from the government and the latter obliged by starting massive agricultural development programmes such as IADP and later SFDA. In these programmes the inputs for modern agriculture (equipment, fertilisers, high yielding variety seeds, pesticides, etc) were provided by the corporate sector through the government agencies to the farmers. The government paid the corporate sector for goods and service s an d marke the amount a loan and subsidies to the farmers. Thus, the corporate sector's profits were assured. To facilitate the government's loan programmes the corporate houses set-up NGOs who would act as middlemen between the peasantry and the government (using the same logic—government is…
Post-SAP one sees a declining role of the Centre in the health sector. The opening up of the econ... more Post-SAP one sees a declining role of the Centre in the health sector. The opening up of the economy has allowed state governments to directly negotiate with agencies like World Bank and this has meant taking some initiative on the policy front even if it is driven by the lending agency. In this context a number of state governments have set up think tanks and/or policy groups to facilitate policy making and planning for the health sector. In this document we will historically trace the evolution of health policy making in India in the context of the development of the health sector. We will also review the current scenario and suggest future directions for policy initiatives.
... Given the responses on the unmet need expressed by respondents, it is evident that if public ... more ... Given the responses on the unmet need expressed by respondents, it is evident that if public health services were in easy ... By contrast, the private health sector fulfils those expectations yet at a tremendous cost to the patient. ... Demand for Public Health-Care Services in Mumbai. ...
The health insurance business in India has seen a growth of over 25% per annum in the last few ye... more The health insurance business in India has seen a growth of over 25% per annum in the last few years with the expansion of the private health insurance sector. The premium incomes of health insurance have crossed the Rs 8,000 crore mark with the share of private companies increasing to over 41%. This is despite the fact that from the perspective of patients, health insurance is not a good deal, especially when they need it most. This raises a number of ethical issues regarding how the health insurance business runs and how medical practice adjusts to it for profiteering. This article uses the personal experience of the author to argue that health insurance in an unregulated environment can only lead to unethical practices, further victimising the patient. Further, publicly financed healthcare which operates in an environment regulating both public and private healthcare provisioning is the only way to assure access to ethical and equitable healthcare to people.
The way in which healthcare is financed is critical for equity in access to healthcare. At presen... more The way in which healthcare is financed is critical for equity in access to healthcare. At present the proportion of public resources committed to healthcare in India is one of the lowest in the world, with less than one-fifth of health expenditure being publicly financed. India has large-scale poverty and yet the main source of financing healthcare is out-of-pocket expenditure. This is a cause of the huge inequities we see in access to healthcare. The article argues for strengthening public investment and expenditure in the health sector and suggests possible options for doing this. It also calls for a reform of the existing healthcare system by restructuring it to create a universal access mechanism which also factors in the private health sector. The article concludes that it is important to overemphasize the fact that health is a public or social good and so cannot be left to the vagaries of the market.
The Health Survey and Development Committee, popularly known as the Bhore Committee, is now 45 ye... more The Health Survey and Development Committee, popularly known as the Bhore Committee, is now 45 years old. Its relevance is not lost even today. This paper briefly reviews the entire three volume report to highlight its wide scope and its comprehensive and progressive nature. It was in the midst of the Second World War and in succession to the Quit-India movement that the Government of India on 18th October 1943 announced the appointment of the Health Survey and Development Committee under the Chairmanship of Sir Joseph Bhore. The terms of referr were simple: (a) a broad survey of the present position in regard to health conditions and health organization in British India, and (b) recommendation for future development. To lend support to the Committee, five Advisory Committees were formed : (i) Public Health (//) Medical Relief (iii) Professional Education (iv) Medical Research and (v) Industrial Health. The advisory Committee deliberations, tours (in all provinces except Assam and Baluchistan), interviews, observations etc. resulted in 206 background papers, memoranda and notes which formed the basis of the final report. This task was accomplished in 26 months.
Access to abortion services is not difficult in India, even in remote areas. Providers of abortio... more Access to abortion services is not difficult in India, even in remote areas. Providers of abortion range from traditional birth attendants to auxiliary nurse midwives and pharmacists, unqualified and qualified private doctors, to gynaecologists. Despite a well-defined law, there is a lack of regulation of abortion services or providers, and the cost to women is determined by supply side economics. The state is not a leading provider of abortions; services remain predominantly in the private sector. Abortions in the public sector are free only if the woman accepts some form of contraception; other fees may also be charged. The cost of abortion varies considerably, depending on the number of weeks of pregnancy, the woman's marital status, the method used, type of anaesthesia, whether it is a sex-selective abortion, whether diagnostic tests are carried out, whether the provider is registered and whether hospitalisation is required. A review of existing studies indicates that abortions cost a substantial amount-first trimester abortion averages Rs.500-1000 and second trimester abortion Rs.2000-3000. Given the number of unqualified providers and with 15-20% of maternal deaths due to unsafe abortions, the costs of unsafe abortions must also be counted. It is imperative for the state to regulate the abortion economy in India, both to rationalise costs and assure safe abortions for women.
Given that health is a state subject, an independent working group of experts was set up in Mahar... more Given that health is a state subject, an independent working group of experts was set up in Maharashtra to evolve a framework for Universal Access to Health Care (UAHC) and it has developed a framework document for restructuring the public healthcare system and its financing that will help facilitate the implementation of a UAHC model. This chapter reviews how, over the years, the health financing strategy failed to develop a robust public health financed system through underinvestment in health and further discusses the financing strategy of the proposed Maharashtra UAHC model to establish universal access to healthcare.
The budget proposals are premised on the assumption that health care is an individual’s respons... more The budget proposals are premised on the assumption that health care is an individual’s responsibiity. The government appears to be rapidly shedding its responsibilities to provide accessible health care to its citizens
Disappointingly, the new health policy that appeared to be robust one, has received little suppor... more Disappointingly, the new health policy that appeared to be robust one, has received little support in the Union Budget.
If the Union Budget 2014 is anything to go by , the fiscal policy of the new government shows no ... more If the Union Budget 2014 is anything to go by , the fiscal policy of the new government shows no change. In fact, there is an amazing continuity with the previous few Budgets. Significantly however, there are signs that the Union government appears to be abdicating its responsibility towards the social sectors and shifting the onus on the states by sharply reducing allocations in the social sector and rural development and hiking grants in aid to states.
ABSTRACT Countries that have universal or near universal access to healthcare have health financi... more ABSTRACT Countries that have universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. It is this that contributes primarily to equity in healthcare in these countries. All OECD countries, excluding the USA, have such a financing mechanism. It is only countries like India and a number of developing countries, that still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast those who suffer a hand-to-mouth existence, a large majority of the population, are forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non-existent. This paper suggests a framework and strategy for India to move towards financing mechanisms that can create equity. It brings together data on India’s health expenditure and financing and project how a new financing strategy will benefit those who have inadequate access to healthcare presently.
This analysis of the trends in public health expenditure in Maharashtra shows that the State has ... more This analysis of the trends in public health expenditure in Maharashtra shows that the State has to become more proactive in raising resources being allocated to the health sector. The level of public health spending is very low in the state, both as a ratio within the state budget and as a proportion to the SDP.
Pradhan Mantri Fasal Bima Yojana (PMFBY) is a flagship scheme of the Government of India to provi... more Pradhan Mantri Fasal Bima Yojana (PMFBY) is a flagship scheme of the Government of India to provide insurance coverage and financial support to farmers in the event of failure of any of the notified crops, unsown area and damage to harvest produce as a result of natural calamities, pests and diseases to stabilise the income of farmers, and to encourage them to adopt modern agricultural practices. The scheme is a considerable improvement over all previous insurance schemes in India and is heavily subsidised by the state and central governments. The scheme aims to cover 50 percent of the farming households within next 3 years. During its implementation in the last one season, several challenges relating to enrolment, yield estimation, loss assessment, and claim settlement were reported by farmers, insurance companies as well as the state governments. It was also noted that several technological opportunities existed for possibly leveraging support to the Indian crop insurance program ...
Page 1. IFPRI FOCUS 5 FEBRUARY 2001 INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE • 2033 KSTREET, ... more Page 1. IFPRI FOCUS 5 FEBRUARY 2001 INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE • 2033 KSTREET, NW • WASHINGTON, DC 20006-1002 • USA PHONE: +1-202-862-5600 • FAX : +1-202-467-4439 • EMAIL: [email protected] • WEB: www.ifpri.org ...
Countries with universal or near universal access to healthcare have health financing mechanisms ... more Countries with universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. This contributes to both equity in healthcare as well as to low levels of poverty in these countries. It is only in countries like India and a number of developing countries, which still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast, a large majority of the population, who suffers a hand-to-mouth existence, is forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non existent. Thus, the absence of adequate public health investment not only results in poor health outcomes but it also leads to escalation of poverty. This article critically reviews the linkages of poverty with healthcare financing using evidence from national surveys and concludes that public financing is critical to good access to healthcare for the poor and its inadequacy is closely associated with poverty levels in the country.
NGOs are private organisations, but their nature makes them somewhat different from what one gene... more NGOs are private organisations, but their nature makes them somewhat different from what one generally refers to as the private sector. Firstly, organisations operating as NGOs are registered either as 'trusts' or 'societies'. As a consequence, they are not supposed to make profit, unlike the private sector. Secondly, NGOs are involved in the 'development sector'; that is, running programmes such as health, nutrition, family planning, education, water supply and sanitation, urban renewal, housing, research, training and documentation, agriculture related development programmes (IRDP etc) and employment programmes (FFW etc), among others. These constitute what one might call service-NGOs. Another category of groups included under the banner of NGOs are activist groups who are involved in conscientisation and struggle oriented activities, but they may also undertake some services. Organisations that are usually only production-oriented are normally not included under the NGO umbrella. However, some service NGOs may undertake production activities such as agriculture, household industry, etc. And there are also funding agencies which are referred to as NGOs. Thirdly, NGOs are invariably dependent on external sources of financing for their activities (including most activist groups). And finally, a large number of NGOs, especially in rural areas, ru n programmes of the government on a contractual basis because of their (NGOs) supposed dedication and flexibility. This is a more recent phenomena (Fifth Plan onwards)—the government, for instance, gives its own health centre or IRDP project to be run by an NGO because the government believes that its own structure is inefficient, bureaucratic and incapable of reaching the beneficiaries. In 1953 the government set up the Central Social Welfare Board, to provide grant-in-aid to NGOs. Further, in its own development programmes, the government sought the expertise and cooperation of well-known NGOs. This was more so necessary when CDP was evaluated at the end of the First Five Year Plan by the Planning Commission: "Most of the time was spent in solving procedural/administrative wrangles making implementation of programmes inefficient, inadequate and wrongly directed" (GOI, 1958). The government could not ignore the social services sector and the private sector was unwilling to invest in social infrastructure. The private sector, for its ow n expansio and profitability, pushed the government into investing vast public resources in building infrastructures and heavy industry that was essential for economic growth, but more so to facilitate the growth of private capital. As a consequence, the social sectors like health and education were totally neglected— health sector was mainly operated by private practitioners and a large number of hospitals run by NGOs, and the education sector was mainly run by NGOs (missions, public trusts and societies). The NGOs in these early years were largely concentrated i n urba areas, but many were now gradually spreading their tentacles into the countryside, the leaders being Gandhian and Christian missionaries. In the health sector the government, though i principle ha d accepte the Bhore committee recommendation, was still undecisive—even today, the physical targets recommended by the Bhore committee are far from realisation. The anti-malaria and anti-smallpox campaigns were undertaken at the behest and with support of international agencies. It was not until the mid-sixties (Third Plan) that the health infrastructure for rural India got serious attention from the government. This too for two reasons—the resurgence of malaria and the government's decision to give family planning programmes a big boost through the camp approach. This was also the time when the green revolution in India began and the countryside had suddenly come into focus (from the perspective of mainstream economics). The corporate sector showed increased interest in rural India for here was an opportunity to capture rural markets not only with the new agricultural technology but also (due to increased commercialisation of agriculture) with other goods and services. The corporate sector, however, was unwilling to go on its own into the rural areas. It wanted crutches from the government and the latter obliged by starting massive agricultural development programmes such as IADP and later SFDA. In these programmes the inputs for modern agriculture (equipment, fertilisers, high yielding variety seeds, pesticides, etc) were provided by the corporate sector through the government agencies to the farmers. The government paid the corporate sector for goods and service s an d marke the amount a loan and subsidies to the farmers. Thus, the corporate sector's profits were assured. To facilitate the government's loan programmes the corporate houses set-up NGOs who would act as middlemen between the peasantry and the government (using the same logic—government is…
Post-SAP one sees a declining role of the Centre in the health sector. The opening up of the econ... more Post-SAP one sees a declining role of the Centre in the health sector. The opening up of the economy has allowed state governments to directly negotiate with agencies like World Bank and this has meant taking some initiative on the policy front even if it is driven by the lending agency. In this context a number of state governments have set up think tanks and/or policy groups to facilitate policy making and planning for the health sector. In this document we will historically trace the evolution of health policy making in India in the context of the development of the health sector. We will also review the current scenario and suggest future directions for policy initiatives.
... Given the responses on the unmet need expressed by respondents, it is evident that if public ... more ... Given the responses on the unmet need expressed by respondents, it is evident that if public health services were in easy ... By contrast, the private health sector fulfils those expectations yet at a tremendous cost to the patient. ... Demand for Public Health-Care Services in Mumbai. ...
The health insurance business in India has seen a growth of over 25% per annum in the last few ye... more The health insurance business in India has seen a growth of over 25% per annum in the last few years with the expansion of the private health insurance sector. The premium incomes of health insurance have crossed the Rs 8,000 crore mark with the share of private companies increasing to over 41%. This is despite the fact that from the perspective of patients, health insurance is not a good deal, especially when they need it most. This raises a number of ethical issues regarding how the health insurance business runs and how medical practice adjusts to it for profiteering. This article uses the personal experience of the author to argue that health insurance in an unregulated environment can only lead to unethical practices, further victimising the patient. Further, publicly financed healthcare which operates in an environment regulating both public and private healthcare provisioning is the only way to assure access to ethical and equitable healthcare to people.
The way in which healthcare is financed is critical for equity in access to healthcare. At presen... more The way in which healthcare is financed is critical for equity in access to healthcare. At present the proportion of public resources committed to healthcare in India is one of the lowest in the world, with less than one-fifth of health expenditure being publicly financed. India has large-scale poverty and yet the main source of financing healthcare is out-of-pocket expenditure. This is a cause of the huge inequities we see in access to healthcare. The article argues for strengthening public investment and expenditure in the health sector and suggests possible options for doing this. It also calls for a reform of the existing healthcare system by restructuring it to create a universal access mechanism which also factors in the private health sector. The article concludes that it is important to overemphasize the fact that health is a public or social good and so cannot be left to the vagaries of the market.
The Health Survey and Development Committee, popularly known as the Bhore Committee, is now 45 ye... more The Health Survey and Development Committee, popularly known as the Bhore Committee, is now 45 years old. Its relevance is not lost even today. This paper briefly reviews the entire three volume report to highlight its wide scope and its comprehensive and progressive nature. It was in the midst of the Second World War and in succession to the Quit-India movement that the Government of India on 18th October 1943 announced the appointment of the Health Survey and Development Committee under the Chairmanship of Sir Joseph Bhore. The terms of referr were simple: (a) a broad survey of the present position in regard to health conditions and health organization in British India, and (b) recommendation for future development. To lend support to the Committee, five Advisory Committees were formed : (i) Public Health (//) Medical Relief (iii) Professional Education (iv) Medical Research and (v) Industrial Health. The advisory Committee deliberations, tours (in all provinces except Assam and Baluchistan), interviews, observations etc. resulted in 206 background papers, memoranda and notes which formed the basis of the final report. This task was accomplished in 26 months.
Access to abortion services is not difficult in India, even in remote areas. Providers of abortio... more Access to abortion services is not difficult in India, even in remote areas. Providers of abortion range from traditional birth attendants to auxiliary nurse midwives and pharmacists, unqualified and qualified private doctors, to gynaecologists. Despite a well-defined law, there is a lack of regulation of abortion services or providers, and the cost to women is determined by supply side economics. The state is not a leading provider of abortions; services remain predominantly in the private sector. Abortions in the public sector are free only if the woman accepts some form of contraception; other fees may also be charged. The cost of abortion varies considerably, depending on the number of weeks of pregnancy, the woman's marital status, the method used, type of anaesthesia, whether it is a sex-selective abortion, whether diagnostic tests are carried out, whether the provider is registered and whether hospitalisation is required. A review of existing studies indicates that abortions cost a substantial amount-first trimester abortion averages Rs.500-1000 and second trimester abortion Rs.2000-3000. Given the number of unqualified providers and with 15-20% of maternal deaths due to unsafe abortions, the costs of unsafe abortions must also be counted. It is imperative for the state to regulate the abortion economy in India, both to rationalise costs and assure safe abortions for women.
Given that health is a state subject, an independent working group of experts was set up in Mahar... more Given that health is a state subject, an independent working group of experts was set up in Maharashtra to evolve a framework for Universal Access to Health Care (UAHC) and it has developed a framework document for restructuring the public healthcare system and its financing that will help facilitate the implementation of a UAHC model. This chapter reviews how, over the years, the health financing strategy failed to develop a robust public health financed system through underinvestment in health and further discusses the financing strategy of the proposed Maharashtra UAHC model to establish universal access to healthcare.
The budget proposals are premised on the assumption that health care is an individual’s respons... more The budget proposals are premised on the assumption that health care is an individual’s responsibiity. The government appears to be rapidly shedding its responsibilities to provide accessible health care to its citizens
Disappointingly, the new health policy that appeared to be robust one, has received little suppor... more Disappointingly, the new health policy that appeared to be robust one, has received little support in the Union Budget.
If the Union Budget 2014 is anything to go by , the fiscal policy of the new government shows no ... more If the Union Budget 2014 is anything to go by , the fiscal policy of the new government shows no change. In fact, there is an amazing continuity with the previous few Budgets. Significantly however, there are signs that the Union government appears to be abdicating its responsibility towards the social sectors and shifting the onus on the states by sharply reducing allocations in the social sector and rural development and hiking grants in aid to states.
ABSTRACT Countries that have universal or near universal access to healthcare have health financi... more ABSTRACT Countries that have universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. It is this that contributes primarily to equity in healthcare in these countries. All OECD countries, excluding the USA, have such a financing mechanism. It is only countries like India and a number of developing countries, that still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast those who suffer a hand-to-mouth existence, a large majority of the population, are forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non-existent. This paper suggests a framework and strategy for India to move towards financing mechanisms that can create equity. It brings together data on India’s health expenditure and financing and project how a new financing strategy will benefit those who have inadequate access to healthcare presently.
This analysis of the trends in public health expenditure in Maharashtra shows that the State has ... more This analysis of the trends in public health expenditure in Maharashtra shows that the State has to become more proactive in raising resources being allocated to the health sector. The level of public health spending is very low in the state, both as a ratio within the state budget and as a proportion to the SDP.
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Papers by Ravi Duggal