{"id":61796,"date":"2025-12-16T16:38:41","date_gmt":"2025-12-16T11:08:41","guid":{"rendered":"https:\/\/www.nextias.com\/ca\/?p=61796"},"modified":"2025-12-17T18:57:32","modified_gmt":"2025-12-17T13:27:32","slug":"universal-health-coverage-india","status":"publish","type":"post","link":"https:\/\/www.nextias.com\/ca\/editorial-analysis\/16-12-2025\/universal-health-coverage-india","title":{"rendered":"The Road to Universal Health Coverage in India"},"content":{"rendered":"\n<p><strong>Syllabus: GS2\/Health\/GS3\/Economy<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Context<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>India committed to <strong>Universal Health Coverage (UHC)<\/strong> through the <strong>National Health Policy (NHP), 2017 and SDG-3<\/strong>, operationalised mainly via <strong>Ayushman Bharat (AB).&nbsp;<\/strong><\/li>\n\n\n\n<li>Despite progress, India continues to face a serious <strong>access\u2013affordability\u2013quality gap, indicating that UHC goals remain underachieved.<\/strong><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What is Universal Health Coverage?<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>It means that all people have<strong> access to the full range of quality health services<\/strong> without financial hardship.&nbsp;<\/li>\n\n\n\n<li><strong>Key components of UHC include:<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Access to Care: <\/strong>Everyone should be able to obtain necessary health services when they need them.<\/li>\n\n\n\n<li><strong>Quality Services: <\/strong>The care provided should be effective, safe, and of good quality.<\/li>\n\n\n\n<li><strong>Financial Protection:<\/strong> Individuals should not face financial difficulties due to medical expenses.&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>UHC <\/strong>is rooted in the <strong>universal human right to health,<\/strong> affirmed in <strong>international covenants and the Alma-Ata Declaration (1978)<\/strong>, which prioritised comprehensive primary healthcare.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Need For Universal Health Coverage in Indian Context<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Historical Commitment to Universal Healthcare:<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Bhore Committee (1943\u201346)<\/strong> reflected a clear preference for universal healthcare over insurance-based UHC.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Policy Evolution after Independence:<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>India&#8217;s National Health Policy of 1983 <\/strong>recognized the goal of <strong>&#8220;Health for All&#8221; <\/strong>and emphasized the importance of primary healthcare and equitable distribution of healthcare resources.&nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Shift towards Insurance-led UHC:<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Welfare Schemes like Rashtriya Swasthya Bima Yojana (RSBY) 2008 and Ayushman Bharat\u2013PMJAY<\/strong> institutionalised UHC but reinforced an insurance-heavy approach.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Weak Public Health System and Rising Private Dependence:<\/strong>\n<ul class=\"wp-block-list\">\n<li>Chronic underfinancing of primary healthcare has led to poor quality public provisioning, shortage of infrastructure and workforce.<\/li>\n\n\n\n<li>National Sample Survey (NSS) data show growing reliance of the poor on private healthcare, rising out-of-pocket expenditure (OOPE) &amp; increased household indebtedness.&nbsp;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Constitutional Basis for UHC:<\/strong>\n<ul class=\"wp-block-list\">\n<li>The <strong>Directive Principles of State Policy<\/strong> in Part IV of the Constitution provides a basis for the right to health.&nbsp;<\/li>\n\n\n\n<li><strong>Article 39 (e) <\/strong>directs the state to secure the health of workers; <strong>Article 42 <\/strong>emphasises just and humane conditions of work and maternity relief; and <strong>Article 47<\/strong> casts a duty on the state to raise the nutrition levels and standard of living, and to improve public health.&nbsp;<\/li>\n\n\n\n<li>The Constitution also endows the panchayats and municipalities to strengthen public health under <strong>Article 243G<\/strong>.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Post-Covid Realisation:<\/strong>\n<ul class=\"wp-block-list\">\n<li>The Covid-19 pandemic exposed inequities in insurance-based access, exclusion of informal workers and migrants &amp; fragility of hospital-centric models.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Present Policy Direction:<\/strong>\n<ul class=\"wp-block-list\">\n<li>Currently, India aims to attain UHC through the expansion of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the flagship publicly financed health insurance (PFHI) scheme of the Union government.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Challenges in Adopting UHC in India<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Resource Constraints:<\/strong> India faces significant funding limitations in healthcare, with a low public health expenditure compared to many other countries. This affects the ability to provide comprehensive services.\n<ul class=\"wp-block-list\">\n<li>Low public health expenditure (~2.1% of GDP), below the NHP target of 2.5%.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Infrastructure Gaps: <\/strong>Many areas, especially rural regions, lack adequate healthcare infrastructure, including hospitals, clinics, and trained personnel, making access to care difficult.<\/li>\n\n\n\n<li><strong>Healthcare Workforce Shortages:<\/strong> There is a shortage of healthcare professionals, particularly in rural areas, leading to disparities in access and quality of care.<\/li>\n\n\n\n<li><strong>Fragmented Health Systems: <\/strong>India&#8217;s healthcare system is a mix of public and private providers, leading to inconsistencies in quality and accessibility.\n<ul class=\"wp-block-list\">\n<li>And, <strong>Health is a State subject<\/strong>, while financing and flagship schemes are centrally driven, leading to uneven outcomes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-background has-fixed-layout\" style=\"background-color:#fff2cc\"><tbody><tr><td><strong>Lessons from Global Experience<\/strong><br><br>&#8211; <strong>WHO Alma-Ata Declaration (1978)<\/strong> emphasised primary healthcare as the foundation of UHC.<br>&#8211; <strong>Several East Asian countries<\/strong> adopted <strong>UHC <\/strong>through an <strong>insurance approach, <\/strong>but have also <strong>strengthened primary and secondary care over time.<\/strong><br>a. <strong>An ageing population and chronic diseases<\/strong> have necessitated such changes.<br>&#8211; <strong>Countries like China and South Korea<\/strong> achieved near-universal insurance coverage <strong>but faced high fiscal costs.<\/strong><br>&#8211; <strong>Recognising sustainability issues, China shifted strategy towards:<\/strong><br>a. Strengthening primary and secondary care.<br>b. Emphasising prevention, early detection, and follow-up.<br>c. Investing in human resources and population outreach.<br>d. A strong public sector helped regulate private providers, though private influence remains a challenge.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img data-dominant-color=\"c8d6d3\" data-has-transparency=\"false\" loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"559\" src=\"https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-96-1024x559.png\" alt=\"universal health coverage\" class=\"not-transparent wp-image-61797\" style=\"--dominant-color: #c8d6d3; aspect-ratio:1.8318737860769414;width:428px;height:auto\" srcset=\"https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-96-1024x559.png 1024w, https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-96-300x164.png 300w, https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-96-768x419.png 768w, https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-96-1536x838.png 1536w, https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-96.png 1600w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n<p><strong>Making Ayushman Bharat 2.0 More Effective<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Shift from Coverage to Care: <\/strong>Move from hospitalisation-centric insurance to universal healthcare.\n<ul class=\"wp-block-list\">\n<li>Strengthen comprehensive primary healthcare as the first point of contact.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Strengthen Primary and Secondary Care:<\/strong> Invest in infrastructure, diagnostics, medicines and referral systems.\n<ul class=\"wp-block-list\">\n<li>Use HWCs as gatekeepers to reduce avoidable hospitalisation.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img data-dominant-color=\"d5e5ec\" data-has-transparency=\"false\" loading=\"lazy\" decoding=\"async\" width=\"683\" height=\"373\" src=\"https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-97.png\" alt=\"making ayushman bharat 2.0 more effective\" class=\"not-transparent wp-image-61804\" style=\"--dominant-color: #d5e5ec; width:298px;height:auto\" srcset=\"https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-97.png 683w, https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/image-97-300x164.png 300w\" sizes=\"auto, (max-width: 683px) 100vw, 683px\" \/><\/figure>\n<\/div>\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Increase Public Investment: <\/strong>Raise health spending to at least 2.5% of GDP.\n<ul class=\"wp-block-list\">\n<li>Prioritise preventive and promotive care and social determinants of health.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Digital and Human Resource Reforms:<\/strong> Integrate ABHA ID, interoperable health records and disease surveillance.\n<ul class=\"wp-block-list\">\n<li>Address workforce shortages through task-shifting, local recruitment and continuous training.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Better Regulation and Strategic Purchasing:<\/strong> Standard treatment guidelines, cost controls and accountability mechanisms.\n<ul class=\"wp-block-list\">\n<li>Align insurance schemes within a strong public health system, as seen globally.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-background has-fixed-layout\" style=\"background-color:#ebecf0\"><tbody><tr><td><strong>Daily Mains Practice Question<\/strong><br><strong>[Q] <\/strong>Financial protection without strong public health provisioning can deepen healthcare inequities. Examine<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Source: <\/strong><a href=\"https:\/\/indianexpress.com\/article\/opinion\/columns\/not-just-insurance-indians-need-universal-healthcare-10422100\/\" target=\"_blank\" rel=\"noopener\"><strong>IE<\/strong><\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/www.nextias.com\/ca\/wp-content\/uploads\/2025\/12\/Daily-Editorial-Analysis-16-12-2025.pdf\"><strong>Download PDF<\/strong><\/a><\/div>\n<\/div>\n\n\n","protected":false},"excerpt":{"rendered":"<p><strong>Published on:<\/strong> 16th December, 2025<\/p>\n<p>\nIndia committed to Universal Health Coverage (UHC) through the National Health Policy (NHP), 2017 and SDG-3, operationalised mainly via Ayushman Bharat (AB).\u00a0\n<\/p \n\n","protected":false},"author":4,"featured_media":61807,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[22],"tags":[],"class_list":["post-61796","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-editorial-analysis"],"acf":[],"jetpack_featured_media_url":"https:\/\/wp-images.nextias.com\/cdn-cgi\/image\/format=auto\/ca\/uploads\/2025\/12\/universal-health-coverage.webp","_links":{"self":[{"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/posts\/61796","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/comments?post=61796"}],"version-history":[{"count":8,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/posts\/61796\/revisions"}],"predecessor-version":[{"id":61996,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/posts\/61796\/revisions\/61996"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/media\/61807"}],"wp:attachment":[{"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/media?parent=61796"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/categories?post=61796"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nextias.com\/ca\/wp-json\/wp\/v2\/tags?post=61796"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}