Smart Cards for All: Digitalisation of Universal Health Coverage in India

2020 ◽  
Vol 25 (3) ◽  
pp. 426-443
Author(s):  
Marine Al Dahdah ◽  
Rajiv K. Mishra
Keyword(s):  
Health Services ◽  
Smart Card ◽  
Universal Health Coverage ◽  
Poverty Line ◽  
Public Private Partnership ◽  
Health Coverage ◽  
Indian States ◽  
Private Partnership ◽  
Access To Health ◽  
Universal Health

In less than ten years, India has launched colossal biometric databases. One among them is related to the first ‘free’ health coverage scheme offered by the government of India: the Rashtriya Swasthya Bima Yojna (RSBY). Based on a public–private partnership between government and private companies, RSBY national scheme was launched in 2008, as a first step towards universal health coverage in a country where households endorse 70% of health expenses. The first phase of RSBY offers to cover ₹30,000 ($600) of inpatient expenses per year for five members of a below poverty line household and is now piloted in several Indian States to include outpatient expenses and above poverty line families too. RSBY relies exclusively on a centralised digital artefact to function, made visible by the ‘RSBY Smart Card’, a chip enabled plastic card containing personal data of individual and their family counting and conditioning the granting of health services to them; thus, no smart card means no health coverage. Till date 120 million Indians have been registered in the RSBY database. This article analyses how health accessibility is crafted under the RSBY scheme by questioning two central dimensions of this data-driven digital health scheme: the smart card technology and the public–private partnership, whereas RSBY scheme promises health coverage for all, its digital infrastructures may complicate access to health services, and reveal new patterns of exclusion of individuals. Thus, we will detail how smartcards technologies and private providers condition access to health care in India.

scholarly journals Financial Barriers to Access to Health Services for Adult People with Disability in Iran: The Challenges for Universal Health Coverage

2019 ◽  
Author(s):  
Shahin SOLTANI ◽  
Amirhossein TAKIAN ◽  
Ali AKBARI SARI ◽  
Reza MAJDZADEH ◽  
Mohammad KAMALI
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Health Coverage ◽  
Access To Health Services ◽  
Financial Barriers ◽  
Access To Health ◽  
People With Disability ◽  
Universal Health

Background: Reducing inequities in access to healthcare is one of the most important goals for all health systems. Financial barriers play a fundamental role here. People with disability (PWD) experience further financial barriers in access to their needed healthcare services. This study aimed to explore the causes of barriers in access to health services for PWD in Tehran, Iran. Methods: In this qualitative study, we used semi-structured in-depth interviews to collect data and selected participants through purposeful sampling with maximum variation. We conducted 56 individual interviews with people with disability, healthcare providers and policymakers from Sep 2015 until May 2016, at different locations in Tehran, Iran. Results: We identified four categories and eight subcategories of financial barriers affecting access to healthcare services among PWD. Four categories were related to health insurance (i.e. lack of insurance coverage for services like dentistry, occupational therapy and speech therapy), affordability (low income for PWD and their family), financial supports (e.g. low levels of pensions for people with disabilities) and transportation costs (high cost of transportation to reach healthcare facilities for PWD). Conclusion: Financial problems can lead to poor access to health care services. To achieve universal health coverage, government should reduce health insurance barriers and increase job opportunities and sufficient financial support for PWD. 

scholarly journals “Living long in India”– India’s progress towards Universal Health Coverage

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Balraj ◽  
H Brand
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Indian Population ◽  
Healthcare Services ◽  
Fiscal Year ◽  
Health Coverage ◽  
Indian States ◽  
Universal Health

Abstract Issue There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these issues and achieve Universal Health Coverage (UHC), India launched the healthcare scheme ‘Ayushman Bharat’ (“long live India”) in 2018. Description The Ayushman Bharat (AB) scheme has two components which include 1) transforming the existing primary healthcare centers (PHC) under the control of State Governments and 2) the National Health Protection Scheme (NHPS) also known as “ModiCare” - a health insurance. The scheme aims to transform nearly 150.000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. NHPS covers the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. The coverage will be approximately €6.400 per year per beneficiary family; 60% of the costs are borne by the Centre and 40% by the States. Results Approximately €127 million have already been allocated by the Centre towards the AB scheme for the fiscal year 2018-19. Till date, around 29 million health insurance cards have been issued, approximately 1,8 million beneficiaries have been admitted and around 15.291 hospitals have been empaneled under NHPS. However, there is no data available validating the usage of the health services yet. Few Indian states are yet to implement the AB scheme. Lessons For the first time, attempts have been made to provide affordable healthcare services to the Indian population under a single common initiative. However, the AB scheme fails to cover outpatient health services, which are an important part of OOP expenses in India. Main message The effort to launch Ayushman Bharat in a big, democratic and diverse country like India has to be lauded, which not only aims to make healthcare services affordable but also aligns itself to the concept of UHC.

scholarly journals A glance on public private partnership: an opportunity for developing nations to achieve universal health coverage

2019 ◽  
Vol 6 (3) ◽  
pp. 1353
Author(s):  
Reena Titoria ◽  
Anu Mohandas
Keyword(s):  
Universal Health Coverage ◽  
Financial Management ◽  
Public Private Partnership ◽  
Health Coverage ◽  
Unequal Distribution ◽  
Private Partnership ◽  
Significant Difference ◽  
The Government ◽  
Resource Service ◽  
Universal Health

The government of India has joined hands with the rest of the world aiming at universal health coverage (UHC) and has set the target for 2022. The huge population, the difficult land terrain, unequal distribution of health care system, socio-economic and cultural factors are posing serious challenges. Public private partnership (PPP) even though not exactly a novel concept, some innovations can tackle these challenges to an extent and give us a smooth track towards UHC. In the past, PPP models were utilized to some extent for development and refurbishment of health infrastructure. But expanding the partnership between the two sectors to human resource, service delivery and financial management with supervision and monitoring by the government may bring out the needed significant difference.

scholarly journals Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

2017 ◽  
Vol 25 (0) ◽  
Author(s):  
Denise Bryant-Lukosius ◽  
Ruta Valaitis ◽  
Ruth Martin-Misener ◽  
Faith Donald ◽  
Laura Morán Peña ◽  
...  
Keyword(s):  
Latin America ◽  
Universal Health Coverage ◽  
Universal Access ◽  
Advanced Practice Nursing ◽  
Advanced Practice ◽  
Health Coverage ◽  
Access To Health ◽  
The Caribbean ◽  
Universal Health ◽  
Role Implementation

ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.

scholarly journals A Hybrid Decision-Making Approach for the Service and Financial-Based Measurement of Universal Health Coverage for the E7 Economies

2019 ◽  
Vol 16 (18) ◽  
pp. 3295 ◽  
Author(s):  
Xiaofeng Shi ◽  
Jianying Li ◽  
Fei Wang ◽  
Hasan Dinçer ◽  
Serhat Yüksel
Keyword(s):  
Decision Making ◽  
Universal Health Coverage ◽  
Health Spending ◽  
Poverty Line ◽  
Negative Influence ◽  
World Health ◽  
Annual Growth Rate ◽  
Health Coverage ◽  
Fuzzy Dematel ◽  
Universal Health

The aim of this study is to measure universal health coverage in Emerging 7 (E7) economies. Within this framework, five different dimensions and 14 different criteria are selected by considering the explanations of World Health Organization and United Nations regarding universal health coverage. While weighting the dimensions and criteria, the Decision-making Trial and Evaluation Laboratory (DEMATEL) is considered with the triangular fuzzy numbers. Additionally, Multi-Objective Optimization on the basis of Ratio Analysis (MOORA) approach is used to rank E7 economies regarding Universal Health Coverage (UHC) performance. The novelty of this study is that both service and financial based factors are taken into consideration at the same time. Additionally, fuzzy DEMATEL and MOORA methodologies are firstly used in this study with respect to the evaluation of universal health coverage. The findings show that catastrophic out of pocket health spending, pushed below an international poverty line and annual growth rate of real Gross Domestic Product (GDP) per capita are the most significant criteria for universal health coverage performance. Moreover, it is also concluded that Russia is the country that has the highest universal health coverage performance whereas China, India and Brazil are in the last ranks. It can be understood that macroeconomic conditions play a very significant role on the performance of universal health coverage. Hence, economic conditions should be improved in these countries to have better universal health coverage performance. Furthermore, it is necessary to establish programs that provide exemptions or lower out-of-pocket expenditures which will not prevent the use of health services. This situation can protect people against the financial risks related to health expenditures. In addition to them, it is also obvious that high population has also negative influence on the countries such as, China and India. It indicates that it would be appropriate for these countries to make population planning for this purpose.

scholarly journals Financial risk protection of Thailand’s universal health coverage: results from series of national household surveys between 1996 and 2015

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Kanjana Tisayaticom ◽  
Rapeepong Suphanchaimat ◽  
Vuthiphan Vongmongkol ◽  
Shaheda Viriyathorn ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Financial Risk ◽  
Health Spending ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Catastrophic Health Spending ◽  
Risk Protection ◽  
Universal Health ◽  
Benefits Package

Abstract Background Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002. Methods We used data from a 15-year series of annual national household socioeconomic surveys (SES) between 1996 and 2015, which were conducted by the National Statistic Office (NSO). The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment (OOP) for health by households exceeding 10 and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8 to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4 and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefits package concertedly support the achievement of UHC goals of access and financial risk protection.

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