Rakesh Sarwal1. 1. Adviser Health, NITI Aayog, New Delhi 110001.
Abstract
BACKGROUND: Universal Health Coverage (UHC) is now recognized as a goal of all health systems, irrespective of income levels. In the absence of a one-size solution, each country has to develop strategies suited to its circumstances. How does the Central Government Health Scheme (CGHS) stand up to the goals and global experience of UHC, and what can be done to make it a model? METHODS: I relied on publicly available documents to identify key features of UHC, and relate it to the architecture of and practices in CGHS. RESULTS: Combining WHO's framework of health systems functions with log frame approach, I constructed a 'UHC status tool' of key elements and expected norms of UHC. CGHS has been performing strongly on financing function and for the range of services covered. It has performed rather poorly on all other elements of UHC. I build the argument for continued public provision of health, as opposed to insurance, on grounds of cost, public good nature of outpatient care and public health services. I suggest and strategize a sequence of reforms in CGHS anchored in health system strengthening, governance and financing, comprehensive primary care and client participation. CONCLUSION: It is both possible and desirable to transform CGHS into a UHC model within the same fiscal space. Merger of finance pools of centrally administered health schemes is suggested as a step towards UHC in India. Copyright 2015, NMJI.
BACKGROUND: Universal Health Coverage (UHC) is now recognized as a goal of all health systems, irrespective of income levels. In the absence of a one-size solution, each country has to develop strategies suited to its circumstances. How does the Central Government Health Scheme (CGHS) stand up to the goals and global experience of UHC, and what can be done to make it a model? METHODS: I relied on publicly available documents to identify key features of UHC, and relate it to the architecture of and practices in CGHS. RESULTS: Combining WHO's framework of health systems functions with log frame approach, I constructed a 'UHC status tool' of key elements and expected norms of UHC. CGHS has been performing strongly on financing function and for the range of services covered. It has performed rather poorly on all other elements of UHC. I build the argument for continued public provision of health, as opposed to insurance, on grounds of cost, public good nature of outpatient care and public health services. I suggest and strategize a sequence of reforms in CGHS anchored in health system strengthening, governance and financing, comprehensive primary care and client participation. CONCLUSION: It is both possible and desirable to transform CGHS into a UHC model within the same fiscal space. Merger of finance pools of centrally administered health schemes is suggested as a step towards UHC in India. Copyright 2015, NMJI.