New Delhi: Government-run hospitals may stop charging for primary services such as investigative tests as India attempts to provide universal health coverage to all its citizens.
“No fee of any kind would be levied on primary healthcare services with the prime source of financing being from general taxation/public exchequer,” the Planning Commission says in its latest health chapter, which Mint has reviewed.
The chapter is part of the government’s effort to lay the roadmap for delivering universal health coverage from the ongoing Plan period (2012-17).
The apex planning body revised the chapter after consultations with the National Advisory Council (NAC) and the health ministry after they expressed displeasure over certain aspects of the document presented in August.
The limited budgetary allocation for universal health coverage in the previous chapter as well as its proposal for a managed network approach, expanding the government’s health insurance programme for the poor, Rashtriya Swasthya Bima Yojana (RSBY), and imposing a user fee to avail health services drew criticism from civil society organizations and the high level expert group (HLEG), which had recommended the overarching framework for implementation of universal health coverage.
NAC’s working group on UHC was formed to “examine the available evidence on the functioning of RSBY and outline an approach to merging of RSBY with UHC” and iron out other differences between the ministries involved within four months.
While the experts have reached a consensus on most issues, the budgetary allocation continues to be point of debate.
“Macro financing remains an issue but it is a reflection of the fiscal position we are in,” said Mirai Chatterjee, an NAC member. “There has been a broader consensus on issues like user fee, which HLEG and NAC had recommended against. The NAC is yet to take a view on the urban health mission.”
The NAC is headed by the ruling Congress party’s chief Sonia Gandhi and sets the social agenda for the United Progressive Alliance government.
The NAC working group on UHC will meet on Friday to take a final call on the subject.
As per the apex planning body’s projections, total funding on core health will be 1.85% of the gross domestic product (GDP) in the next plan period (2012-17).
After including the broader health sector’s spending on water and sanitation, mid-day meals and integrated child development schemes, the funding is likely to increase to 3.02% of GDP by 2017.
Since there are various models of UHC, the Planning Commission has recommended that state governments should experiment with pilot projects at district levels to test global best practices before deciding on how to roll out the scheme.
The health chapter encourages states to “partially fund and run at least one, but up to three UHC pilots in districts through the ‘incentive pool’ under national health mission... medical colleges can be asked to devise rigorous evaluation designs for testing cost-effectiveness, patient’s satisfaction and change in household’s out of pocket expenses.”
Prior to launching pilots projects, resident families will be registered and a district health action plan under the National Health Mission will be prepared.
Local communities and self-governing agencies will participate in grievance redressal, oversight and accountability within the system, states the document.