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Escalating health care costs
constitute an important cause for indebtedness among the poor and middle-income
groups, and lead to the impoverishment of 2.2% of the population annually. The
way a health system is financed is a key determinant of population health and
well-being. In many countries, including India, the level of spending is
still insufficient to ensure equitable access to basic and essential health
services and interventions. Hence, one of the key policy issues is how to
ensure adequate and equitable resource mobilization for health. India is one
of the 192 Member States that adopted the resolution on ‘Sustainable health
financing, universal coverage and social health insurance’ at the World
Health Assembly in May 2005.
Different forms of health system
financing exist, that vary in terms of how resources are generated, pooled
together and used. Alongside, policy-makers need reliable information on the
quantity of financial resources used for health, their sources and the way
they are used, in order to develop policies to enhance the performance of
their health systems. In 2000, the Commission on Macroeconomics and Health
set out to examine the links between health and poverty and to demonstrate
that health investment can accelerate economic growth. The National
Commission on Macro Economics & Health, established in 2004 set to assess the impact of increased
investments in the health sector on poverty reduction and economic
development of India; and to provide the evidence base to formulate a
long-term programme for scaling up essential health interventions, with focus
on the poor.
India spends 4.6 percent of its
GDP on health, of this 0.9 percent is public expenditure and 3.5 percent is
private expenditure. WHO in collaboration with the MOHFW, GOI has developed
National Health Accounts (NHA) for India for the year 2001-02. NHA
provides evidence to monitor trends in health spending for all sectors-
public and private, different health care activities, providers, diseases,
population groups and regions in a country. It helps in developing national
strategies for effective health financing and in raising additional funds for
health. Disease specific NHA estimates for HIV/AIDS have also been developed
for the year 2004-05. With a view to strengthen capacity building at
both National and State level, a training manual on NHA in India has been compiled and
various orientation cum training initiatives have been conducted.
Health insurance is one of the various financing options being
considered in India
to decrease indebtedness. At present, health insurance coverage in India
is extremely limited, especially outside the formal sector. WHO in
partnership with MOFHW, GOI and others has been supporting capacity building
initiatives and facilitating exchange of experiences.
This has resulted in the development of an operational guide for the
planning and implementing health insurance in the country, development of
training manual on health insurance coupled with organization of capacity
building programmes for managers and planners.
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