Page 179 - India Insurance Report 2023- BIMTECH

India Insurance Report - Series II 167

centers are springing up, they are still hounded by a lack of medicines, adequate diagnostic equipment or
even a poor number of healthcare workers! The government has further reiterated, “we have conceived
and implemented program for controlling prices of medicines, and significantly expanding medical
education. We are committed to leveraging all resources to ensure that the out-of-pocket expenditure on
health is reduced and all citizens can avail of necessary medical services.”

Meanwhile, a study in India has found that the odds of incurring catastrophic hospitalization
expenditures were nearly 160% higher for a patient with cancer than the odds of incurring catastrophic
spending when hospitalization was due to a communicable condition (WHO 2011). COVID-19 has
brought these issues of equity in healthcare and the right to health to the forefront of global conversations
and emphasized the importance of universal health coverage in building more resilient health systems
and healthier populations.

The World Health Organization (WHO) declared health as a fundamental human right in its
constitution in 1948 and set the ‘Health for All’ agenda through the Alma Ata declaration in 1978. A
progressive realization of Universal Health Coverage is a universal feature of all the United Nations’
Sustainable Development Goals. UHC provides equal and easy access to quality healthcare facilities for
all people and communities, irrespective of their age, gender, caste or financial standing, that too without
causing them any monetary hardships. In simple terms, this means that everyone everywhere should be
assured that they will get the necessary healthcare when they fall sick. They can get well even if they
don’t have the money to afford medical treatment.

In India, the current medical scenario is centered in urban areas and mostly in the hands of the
private sector. In fact, the public sector only covers about 20% of outpatient and 40% of hospitalization
services in the country. And as we very well know, private healthcare caters to only those who can
afford it. Another poignant fact is that sick people in the villages often literally have to walk hundreds of
kilometres to the nearest town to avail themselves of decent medical facilities! This imbalance has
catapulted even basic healthcare into a commercialized entity – one that is outlined by exorbitant charges
that are only getting more expensive by the day. The out-of-pocket payments are such a heavy burden
that the marginalized sections harbour a morbid fear of health expenses to the extent that they simply
avoid going to the hospital! Sometimes, leaving it until it becomes too late.

It is not as if India has neglected UHC. Successive governments have been drafting different policies,
instituting many mechanisms and making a lot of investments to extend healthcare to all the citizens.
This commitment shines through in the form of beneficial programs like the Central Government
Health Scheme (CGHS), Employees’ State Insurance (ESI), National Rural Health Mission (NRHM),
Rashtriya Swasthya Bima Yojna (RSBY) and the recent Pradhan Mantri Jan Aarogya Yojana (PMJAY),
to name a few.

These social security schemes are a step in the right direction. However, they are mostly plagued by
implementation issues or prove to be largely ineffective in offering universal healthcare access. For
instance, the ESI was a novel program designed to extend functional health insurance coverage to a huge
section of the working population. Every employer is rendered duty bound to enroll all employees
earning Rs. 21,000 or less per month and contribute a certain percentage to a central fund that will cover
contingencies like sickness, injury or disablement. It even provides compensation for missed work due