Intent to strengthen public sector healthcare is evident



WilL 2012 be regarded as a turning point in India's movement for Universal Health Coverage (UHC)? Will 2013 become the launch pad for several new initiatives that will make a major difference to the health of the Indian people? While these questions evoke varied responses ranging from optimism to scepticism, what is the reality check?

The health chapter of the 12th Five Year Plan is a guide to emerging government policy. The transition of the National Rural Health Mission to National Health Mission, with addition of an urban component, is a prominent feature. Increase in public expenditure on health, from 1% of the nation's GDP to 1.87% during this plan period, is welcome even if it falls short of the 2.5% recommended by the Approach Paper to the plan. Higher allocations to water, sanitation and nutrition programmes will also translate into improved health.

The report of the High Level Expert Group (HLEG), established by the Planning Commission, triggered a debate on the modalities of implementing UHC. Stating that a core principle of the National Health Mission would be UHC, the health chapter affirms the goal of providing cashless services to all citizens, from primary to tertiary care. Elsewhere, it states that primary care services will be provided free of cost by the government.

Is the intent is to commence the march to UHC with primary care and complete the journey to higher levels of care over the next two plan periods? The mechanisms by which the government would support service provision in secondary and tertiary care (mainly government provided or purchased; tax-funded or insurance based) are not clear. Even as the Plan proposes piloting of UHC models from 2013, in select districts across the country, a working group of the National Advisory Council (NAC) is examining how best the existing government funded health insurance schemes can be integrated into UHC.

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