Universalising Healthcare in India: Managing the Provider–Purchaser Split

IF 1 Q4 HEALTH POLICY & SERVICES
S. Nagarajan, Shruti Tripathy, P. Sodani, Rachna Sharma
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Abstract

Several countries with diverse health systems have achieved universalization (UHC). The trajectory towards universal coverage almost always has three typical features: (i) a political process driven by a range of regulatory changes to simplify access; (ii) an increase in health spending; (iii) an increase in the share of pooled spending rather than paid out-of-pocket. Therefore, a study was undertaken to understand the extent of the provider-purchaser relationship of governments to achieve UHC while reforming healthcare. The present paper focuses on extensive secondary research across countries and evaluates the experiences of select developed and developing economies with India’s experiments on- Financing mechanisms, management arrangements, governance and health outcomes; to offer a comparison of practices and their impact. While Italy, the UK, Germany, Australia, Japan, Canada and most recently China are countries that have achieved UHC; countries like USA and Brazil are on the verge of achieving UHC. These nine countries represent the entire spectrum of pure purchasing models, mixed and pure provisioning models to help us leverage from their experience. All countries that have attained UHC have a well-defined package of services that the government commits to fund and provide for (both public and private). Additionalities around wellness and cosmetic care is managed through supplementary insurance. Overall funding is through an autonomous body, at arm’s length of government; primarily to govern and manage the state’s health priorities. And the government purely behaves as a regulator setting policy and giving directions to the providers. However, ensuring the sustenance of such a mixed model requires; (i) a well-regulated ecosystem that thrives on evidence, (ii) the governments must clearly define the role/s of each stakeholder and hold them accountable for their deliverables in attaining UHC.
在印度普及医疗保健:管理提供者-购买者分割
卫生系统多样化的几个国家已经实现了全民健康。实现全民覆盖的轨迹几乎总是有三个典型特征:(一)由一系列简化准入的监管变化驱动的政治进程;(ii)增加医疗支出;(iii)增加集合支出的份额,而不是自掏腰包。因此,进行了一项研究,以了解政府在改革医疗保健的同时实现全民健康保险的提供者-购买者关系的程度。本论文侧重于各国广泛的二次研究,并评估了选定的发达经济体和发展中经济体在以下方面的经验:融资机制、管理安排、治理和卫生成果;提供实践及其影响的比较。意大利、英国、德国、澳大利亚、日本、加拿大以及最近的中国都实现了超高温;像美国和巴西这样的国家正处于实现超高温的边缘。这九个国家代表了纯购买模式、混合和纯供应模式的整个范围,以帮助我们利用它们的经验。所有实现全民健康覆盖的国家都有一套明确的服务,政府承诺为其提供资金(包括公共和私人)。健康和美容护理的额外费用通过补充保险进行管理。总体资金是通过一个与政府保持一定距离的自治机构提供的;主要是为了治理和管理该州的卫生优先事项。政府的行为纯粹是作为一个监管机构制定政策并向供应商发出指示。然而,确保维持这种混合模式需要:;(i) (ii)政府必须明确界定每个利益相关者的角色,并让他们对实现全民健康覆盖的可交付成果负责。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Health Management
Journal of Health Management HEALTH POLICY & SERVICES-
CiteScore
3.40
自引率
0.00%
发文量
84
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