By: K. Srinath Reddy
It is my firm belief that our focus needs to go beyond health insurance. The way ahead lies in health assurance. We need to focus on preventive healthcare, where public participation has a major role to play.” This remarkable passage from the recent address by the prime minister to the American Association of Physicians of Indian Origin (read out by the health minister in San Antonio) bodes well for our new health policy.
Health assurance is different from health insurance — often incorrectly used as the basis for universal health coverage (UHC) — in three major ways. First, it denotes a concept of health that goes beyond healthcare. It correctly emphasises the need for providing health in all dimensions, from promotion of positive health and disease prevention to effective illness care. In contrast, health insurance usually covers only clinical care for developed diseases — often selective even in that. Policies in sectors other than health have a profound impact on the health and nutritional status of populations. Potable water, sanitation, environment, agriculture, food processing, education and urban transport are among the sectors where policies and programmes can either enable or erode health. Health insurance does not touch any of these.
Second, even in the arena of healthcare, health assurance encompasses many essential elements of the system, besides the component of financial protection against personal expenditure. To provide an assurance of health, we need to ensure a numerically adequate, technically skilled and socially committed health workforce, which is multilayered but functions as a cohesive team. We need to provide the required physical infrastructure, drugs, equipment and supportive services to make every healthcare facility fully functional and easily accessible. We have to develop accurate real time health information systems that can assist decision-making at all levels, from policymakers to healthcare providers and patients. Innovative technologies need to be developed to enhance the outreach and effectiveness of health services. Access to essential medicines, vaccines and technologies has to be promoted, along with their rational use. Robust regulatory systems have to be created to streamline health-professional education, quality of care and drug control. People have to be empowered, as communities and as individuals, to participate in healthcare design and delivery as informed partners of health professionals and administrators. Good governance and managerial efficiency have to be demonstrated with clearly defined measures of accountability. Health insurance does not address these.
Third, even when it comes to financial protection, health assurance reaches beyond the narrow definition of insurance to provide cost coverage through a combination of several financing mechanisms: tax-funded free provision of essential health services to all citizens; employer-provided health insurance for additional services; government-funded social insurance programmes that provide the unorganised workforce and poor with continued…