UNIVERSAL HEALTH CARE

AMRITA SCHOOL OF DENTISTRY

1. UNIVERSAL HEALTH CARE Seminar no:12 1

2. Introduction History Monitoring and evaluation of UHC UHC service coverge index H igh Level of Expert Group Report on UHC in India Ayushman Bharat National Health Insurance Scheme Role of oral health in UHC Role of national digital health mission on UHC Universal health interface Initiatives of UHC Conclusion References CONTENTS 2

3. Universal Health Coverage or UHC is defined as “ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services”. -(WHO, 2012) INTRODUCTION 3

4. CONCEPT OF UHC 4

5. HISTORY 5

6. 6

7. Role of WHO: UHC is firmly based on the 1948 WHO Constitution. WHO works with many different partners in different situations and for different purposes to advance UHC around the world. Some of WHO’s partnerships include: UHC2030 Alliance for Health Policy and Systems Research P4H Social Health Protection Network UHC Partnership Primary Health-Care Performance Initiative 7

8. To achieve SDG target 3.8 of Universal Health Coverage for all by 2030, at least 1 billion more people will need to have access to essential health services in each five-year period between 2015 and 2030. The essence of UHC is universal access to people- centred health system with primary care as its foundation. Community-based services, health promotion, disease prevention and immunization are key components. 2030 Agenda for SDGs 8

9. Target 3.8 - “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. Two indicators to monitor target 3.8 within the SDG framework. The proportion of a population that can access essential quality health services (SDG 3.8.1) The proportion of the population that spends a large amount of household income on health (SDG 3.8.2). The UHC service coverage index combines 16 essential health services in 4 categories : UHC SERVICE COVERAGE INDEX (3.8) 9

10. Method of measurement For each country, the most recent value for each tracer indicators is taken from WHO or other international agencies Preferred data sources: Household surveys Administrative data Special facility surveys Expected frequency of data dissemination: 2-3 years Expected frequency of data collection: 1-5 years Limitations: Due to data limitations, not all tracer indicators used to compute the index are direct measures of service coverage. These proxy indicators will be replaced in future years when more data become available. 10

11. 11

12. 12

13. 13

14. Monitoring and evaluation framework for PHC This document responds to Member States’ request in resolution WHA on primary health care for guidance to assess, track and monitor PHC performance to accelerate progress towards UHC and the health-related SDGs . The framework presented in this document are based on and support the 14 levers of the Operational framework for primary health care. This document includes WHO’s Thirteenth General Programme of work, as well as other global health system monitoring efforts. 14

15. Strengthening health systems based on primary health care: accelerating progress towards UHC and health security 15

16. Before COVID-19 struck, the world was far short of reaching the Sustainable Goal (SDG) 3.8 targets and the goal of 1 billion more people benefiting from UHC by 2023. 16

17. Disruptions of essential health services due to COVID-19 17

18. COVID-19 and financial protection 18

19. Report, adopted the following definition of Universal Health Coverage (UHC): Ensuring equitable access for all Indian citizens, resident in any part of the country, regardless of income level, social status, gender, caste or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative and rehabilitative) as well as public health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services. -HLEG Constituted on October, 2010 19

20. 20

21. Principles of UHC in India 21

22. THE NEW ARCHITECTURE FOR UHC FOCUS AREAS 22

23. Central government and states should increase public expenditures on health from the current level of 1.2% of GDP to at least 2.5% by the end of 12 th plan, and to at least 3% of GDP by 2022. 23

24. 24

25. Recommended agencies: 1. National Health Regulatory and Development Authority (NHRDA) The System Support Unit (SSU) The National Health and Medical Facilities Accreditation Unit (NHMFAU) The Health System Evaluation Unit (HSEU) 2. National Drug Regulatory Authority (NDRDA) 3. National Health Promotion and Protection Trust (NHPPT) 25

26. Ayushman Bharat Ayushman Bharat, a flagship scheme of Government of India, was launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC). Ayushman Bharat adopts two inter-related components, which are - Health and Wellness Centers (HWCs) Pradhan Mantri Jan Arogya Yojana (PM-JAY) 26

27. Arogya Karnataka – Universal Health Coverage 27

28. The Report of the Primary Health Care Task Force, primary health care provides valuable insights into structure and processes that are required in health systems to enable Comprehensive Primary Health Care (CPHC). The Twelfth Five Year Plan Identified Universal Health Coverage as a key goal and based on the recommendations of the High- Level Expert Group Report on UHC had called for 70% budgetary allocation to Primary Health Care in pursuit of UHC for India. 28

29. NATIONAL HEALTH INSURANCE SCHEMES 29

30. 1.Rashtiya Swasthiya Bima Yojana (RSBY) To provide health insurance coverage for Below Poverty Line (BPL) families. Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- for most of the diseases that require hospitalization. The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of 23 million families have been enrolled as of February 2011. 30

31. Unique Features of RSBY 31

32. 2.Employment State Insurance Scheme (ESIS) Employees’ State Insurance Scheme of India, is a multidimensional social security system tailored to provide socio-economic protection to worker population and their dependants covered under the scheme. Applicability The Act is applicable to non-seasonal factories employing 10 or more persons. The Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatres, road-motor transport undertakings and newspaper establishments employing 20 or more persons. The Scheme has been extended to Private Medical and Educational institutions employing 20 or more persons in certain States/UTs. Areas covered States :- All the States except Manipur, Sikkim, Arunachal Pradesh and Mizoram. Union territories :- Delhi and Chandigarh 32

33. 3.Central Government Health Scheme (CGHS) Provides comprehensive health care facilities for the Central Govt. employees and pensioners and their dependents residing in CGHS covered cities. Started in New Delhi in 1954. The medical facilities are provided through Wellness Centres /polyclinics under  all systems of medicines. The main components of the Scheme are: The dispensary services including domiciliary care F. W. & M.C.H. Services Specialists consultation facilities both at dispensary, polyclinic and hospital level including X-Ray, ECG and Laboratory Examinations. Hospitalization Organization for the purchase, storage, distribution and supply of medicines and other requirements Health Education to beneficiaries 33

34. 34

35. 4. Aam Aadmi Bima Yojana(AABY) Aam admi bima yojana, a Social Security Scheme for rural landless household was launched on 2nd October, 2007. A separate fund called "Aam Admi Bima Yojana Premium Fund" has been set up by Central Govt. to pay the Govt. contribution. Fund is maintained by LIC. 6.Universal Health Insurance Scheme (UHIS) The four public sector general insurance companies have been implementing Universal Health Insurance Scheme for improving the access of health care to poor families. The Universal Health Insurance Scheme (UHIS) has been redesigned targeting only the BPL families. The Universal Health Insurance Scheme was launched on a countrywide basis in July 2003 with an objective to provide health care to poorest section of the society. 35

36. 36

37. Megha Health Insurance Scheme (MHIS) The Megha Health Insurance Scheme (RSBY + UHIS) was launched on 15th December, 2012 by then Chief Minister Dr Mukul Sangma, in convergence with Rashtriya Swasthiya Bima Yojana (RSBY). The objective to provide financial aid to all the citizens of the state at the time hospitalization and reduce the out-of-pocket expenses of the residents of the State (excluding state and central government employees) 37

38. 38

39. A majority of the world’s extreme poor people resided in low income countries, until India moved from the low income group to the lower-middle income group in 2007. China and India, due to their population size and economic development, have had an enormous influence on global patterns of poverty and health aid. 39

40. Government Subsidized health insurance schemes: India has multiple types of health insurance schemes. They can broadly be bucketed into three categories based on financing source (Government tax revenue or contribution based), target group (e.g., formal sector workers), and compulsory versus voluntary nature of the scheme. These schemes provide fully or partially subsidized insurance coverage to specific targeted segments of the population. Social Health Insurance (SHI) Schemes Private voluntary health insurance (PVHI) schemes 40

41. 41

42. HEALTH INSURANCE / ASSURANCE IN INDIA: NEED AND LANDSCAPE Low financial protection leads to high out-of-pocket expenditure (OOPE). Pre-payment through health insurance emerges as an important tool for risk-pooling and safeguarding against catastrophic (and often impoverishing) health expenditure. Pre-paid pooled funds can also improve the efficiency of healthcare provision. 42

43. RECOMMENDATIONS AND PATHWAYS TO INCREASING HEALTH INSURANCE COVERAGE 43

44. Aarogya Sanjeevani Health Insurance Plan The Insurance Regulatory Development Authority of India (IRDAI) launched a standardized health insurance product – Arogya Sanjeevani – in April 2020. The sum insured is flexible – varying between Rs. 50,000 to Rs. 10 lakhs – based on the needs of the individual, or the family. Designing a low-cost comprehensive health insurance product for the missing middle: 44

45. Role of Oral Health in UHC FDI welcomed the commitment to strengthen oral health in the United Nations (UN) Political Declaration on Universal Health Coverage (UHC), which was officially adopted by world leaders at the UN High-Level Meeting on UHC on September 23 in New York. WHO’s 13th Global Programme of Work 2019–2023 with its focus on UHC can help move the global oral health agenda forward. More than half of the world’s population (3.5 billion) suffer from untreated oral diseases, which can result in pain, infection, tooth loss and loss of productivity. In 2010 direct treatment costs due to oral diseases worldwide were estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure FACTS 45

46. Vision To create a National Digital Health Eco-system that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, through provision of a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems, and ensuring the security, confidentiality and privacy of health-related personal information. ROLE OF NATIONAL DIGITAL HEALTH MISSION ON UHC 46

47. UNIVERSAL HEALTH INTERFACE 47

48. Universal health interface benefits: 48

49. 49

50. 50

51. 51

52. UMID Card by Indian Railways Features of the UMID cards : Electronic Platform Card Free System Change of Health Units Automatic Generation of OPD Slips Hospital-wise Debits and Credits Hassle-free Usage Both Web and Mobile Application Applicability and Scalability Continuous Validation Mechanism CSTE Scheme Hospitals Referral Hospitals Interfacing 52

53. 53

54. Universal Health Services, Inc. (UHS) is one of the largest and most respected providers of hospital and healthcare services in the US dedicated to improving people’s lives and transforming the delivery of healthcare. Through its subsidiaries, the company operates 28 Acute Care hospitals, 335 Behavioral Health inpatient facilities, and 40 outpatient facilities and ambulatory care centers in 39 states in the U.S., Washington, D.C., Puerto Rico and the United Kingdom. 54

55. Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. 55

56. CONCLUSION 56

57. REFERENCES https://www.who.int/health-topics/universal-health-coverage#tab=tab_1 https://www.who.int/publications/i?healthtopics=6b21a1ad-3bdd-44ba-a311-4abafa4efef3 https://www.niti.gov.in/long-road-universal-health-coverage#:~:text=India%20is%20committed%20to%20achieving,per%20cent%20of%20the%20population. https://www.nhp.gov.in/universal-health-coverage_pg https://uiic.co.in/en/taxonomy/term/1283 https://www.etrainstatus.com/railnews/umid-card-by-indian-railways/ https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc) https://www.commonwealthfund.org/international-health-policy-center/countries/india https://gh.bmj.com/content/5/9/e003801 https://www.bankbazaar.com/health-insurance/universal-health-insurance-scheme.html https://journals.sagepub.com/doi/abs/10.1177/0971721820912920?journalCode=stsa https://www.nhp.gov.in/national-health-insurance-schemes_pg 57

58. https://nha.gov.in/PM-JAY https://financialservices.gov.in/insurance-divisions/Government-Sponsored-Socially-Oriented-Insurance-Schemes/Pradhan-Mantri-Suraksha-Bima-Yojana(PMSBY) https://iphindia.org/implementation-indias-national-health-insurance-scheme-experience-field/ https://www.healthindiatpa.com/rsby/index.aspx https://www.uhs.com/ https://pnhp.org/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541093/ https://mhis.org.in/ https://www.researchgate.net/publication/274313651_Universal_Health_Coverage_for_Inclusive_and_Sustainable_Development_A_Synthesis_of_11_Country_Case_Studies https://www.ncbi.nlm.nih.gov/books/NBK373408/ https://in.one.un.org/task-teams/universal-health-coverage/ 58

59. Thank You 59