State Level Strategies for Health Insurance and Health Care

Health is a State subject in India. For most States it is clear that given the level of financing that is available for the provision of healthcare, it would not be possible to offer universal healthcare no matter what method of purchasing is used or whether the private sector or the public sector emerge as the principal providers. For these States, given the fact that the resources are not immediately available, the question is how to ensure that, as they gradually acquire the financial capacity; build the political will; and begin to put in place the human resources and the physical infrastructure required for Universal Health Care (UHC), the immediate healthcare and financial protection needs of the population are addressed in such a manner that in trying to address immediate needs it does not start to move in a direction opposite to the one that is best suited for the achievement of the UHC goal even in the longer term. The current fragmented approaches being followed State governments present a number of urgent challenges that need to be addressed and have the real danger that they will make the goal of UHC unattainable even in the longer run because of the creation of excess and concentrated hospital capacity, populations getting accustomed to free-market choice structure for seeking health services, and continued relative under-funding of primary healthcare leading to larger and larger unaddressed burdens of disease. Following a hybrid approach that combines insurance with strong state financed/provided primary care may provide a potential solution that is also politically viable.