2. About the National Health Policy

The National Health Policy (NHP) is a comprehensive framework that outlines the government's vision, goals, and strategies for addressing healthcare challenges and improving the health outcomes of the population. It serves as a guiding document for healthcare planning, resource allocation, and implementation of health programs and initiatives.

Key components of a National Health Policy typically include

• The NHP articulates the government's vision for the healthcare system and sets specific goals and targets to be achieved over a defined period. These goals often encompass areas such as improving access to healthcare services, enhancing the quality of care, reducing health inequalities, and promoting health and well-being.
• It outlines strategies for organizing and delivering healthcare services, including the development of infrastructure, human resources, and healthcare facilities. This may involve expanding healthcare coverage, strengthening primary healthcare services, and integrating various levels of care within the health system.
• The NHP addresses mechanisms for financing healthcare services, including public funding, health insurance schemes, and other financial instruments. It may outline strategies for increasing public spending on health, mobilizing resources, and ensuring equitable access to affordable healthcare for all segments of the population.
• The policy emphasizes the importance of health promotion, disease prevention, and public health interventions to improve population health outcomes. This may include initiatives to promote healthy lifestyles, prevent communicable and non-communicable diseases, and address social determinants of health.
• It establishes regulatory frameworks and standards for healthcare delivery, quality assurance, and patient safety. This may involve licensing and accreditation of healthcare facilities, regulation of healthcare professionals, and monitoring of healthcare quality and outcomes.
• The NHP recognizes the importance of partnerships and collaboration between government agencies, healthcare providers, civil society organizations, and other stakeholders to achieve its goals. It may involve engaging multiple sectors beyond healthcare, such as education, agriculture, and urban planning, to address health determinants comprehensively.
• The policy includes mechanisms for monitoring and evaluating progress towards its goals and objectives. This may involve the development of health indicators, data collection systems, and periodic assessments to track performance, identify gaps, and inform policy adjustments.

3. What is Primary healthcare?

Primary healthcare refers to essential health services that are universally accessible to individuals and communities. It is typically the first point of contact with the healthcare system for most people and plays a crucial role in promoting health, preventing diseases, and managing common health problems.

Key characteristics of primary healthcare include

• Primary healthcare services are geographically and financially accessible to all members of the community, regardless of their socioeconomic status, location, or background. This accessibility ensures that individuals can seek care when needed without encountering barriers related to distance or cost.
• Primary healthcare addresses a wide range of health needs across the lifespan, including preventive care, health promotion, treatment of common illnesses, management of chronic conditions, and referral to specialized services when necessary. It emphasizes holistic and patient-centered care that considers the physical, mental, and social aspects of health.
• Primary healthcare services are integrated across different levels of care, from individual clinics and health centres to community-based programs and outreach services. This integration fosters coordination and continuity of care, ensuring seamless transitions between different healthcare providers and settings.
• Primary healthcare empowers individuals and communities to take control of their health and well-being through health education, counselling, and community engagement. It promotes active participation and self-management, empowering individuals to make informed decisions about their health and lifestyle choices.
• Primary healthcare strives to address health inequalities and disparities by ensuring that healthcare services are distributed fairly and reach underserved populations, including marginalized groups, rural communities, and vulnerable populations. It promotes equity in access to healthcare and health outcomes for all individuals, regardless of their background or circumstances.
• Primary healthcare involves collaboration and teamwork among different healthcare professionals, including doctors, nurses, midwives, pharmacists, community health workers, and allied health professionals. This interdisciplinary approach allows for a comprehensive and holistic response to the diverse health needs of individuals and communities.

4. What is out-of-pocket expenditure?

Out-of-pocket expenditure (OOP) refers to the direct payments made by individuals or households for healthcare goods and services at the point of receiving care. These expenses are typically paid for by individuals using their own funds rather than being covered by a third-party payer, such as government health insurance, private health insurance, or employer-sponsored health plans.

Key characteristics of out-of-pocket expenditure include

• OOP expenses are incurred by individuals or households at the time they receive healthcare services. This may include payments for doctor's visits, hospital stays, prescription medications, diagnostic tests, medical procedures, and other healthcare-related expenses.
• OOP expenses are incurred when healthcare services are not fully covered by health insurance or other third-party payers. They represent the portion of healthcare costs that individuals are responsible for paying themselves, either because they do not have insurance coverage or because their insurance plan requires them to pay deductibles, copayments, coinsurance, or other cost-sharing amounts.
• OOP expenses can vary widely depending on factors such as the type and severity of the health condition, the type of healthcare provider or facility visited, the location of services, and the individual's insurance coverage. Some healthcare services may be relatively inexpensive, while others may involve significant out-of-pocket costs, especially for specialized or high-cost treatments.
• OOP expenses can impose a significant financial burden on individuals and households, particularly those with limited financial resources or those facing high healthcare costs. In some cases, out-of-pocket spending on healthcare can lead to financial hardship, medical debt, or barriers to accessing necessary care, especially for vulnerable or marginalized populations.
• High levels of out-of-pocket spending can deter individuals from seeking timely and appropriate healthcare services, leading to delays in diagnosis and treatment, underutilization of preventive services, and poorer health outcomes. This is particularly relevant in low- and middle-income countries where healthcare costs may represent a substantial proportion of household income.
• Policymakers often seek to reduce out-of-pocket spending on healthcare by implementing measures to expand health insurance coverage, increase financial protection, and improve access to affordable healthcare services. This may include initiatives such as universal health coverage, social health insurance schemes, subsidies for health insurance premiums, or waivers for certain categories of patients.

5. How non-communicable diseases (NCDs) has become a challenge for India?

Non-communicable diseases (NCDs) have become a significant challenge for India due to several interrelated factors

• India is experiencing a rapid epidemiological transition characterized by a shift from communicable diseases to non-communicable diseases. Lifestyle changes, urbanization, sedentary lifestyles, unhealthy diets, tobacco use, and increasing life expectancy have contributed to the rising prevalence of NCDs such as cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases.
• NCDs account for a substantial burden of morbidity, mortality, and disability in India. According to the World Health Organization (WHO), NCDs are responsible for more than 60% of all deaths in India. Cardiovascular diseases alone contribute to nearly one-fourth of all deaths, followed by chronic respiratory diseases, cancer, and diabetes.
• NCDs impose a significant economic burden on individuals, households, and the healthcare system. High out-of-pocket expenditures for NCD treatment and management can lead to financial hardship, impoverishment, and barriers to accessing healthcare services, particularly for low-income populations. The economic costs of NCDs include direct medical expenses, indirect costs related to productivity losses and disability, and intangible costs associated with pain and suffering.
• NCDs disproportionately affect vulnerable and marginalized populations, exacerbating existing health inequities and disparities. Socioeconomic factors such as poverty, inadequate access to healthcare, limited health literacy, and environmental factors contribute to disparities in NCD risk factors, prevalence, and outcomes across different population groups.
• India's healthcare system faces challenges in addressing the growing burden of NCDs, including inadequate infrastructure, limited human resources, fragmented healthcare delivery, and gaps in prevention, diagnosis, and management services. There is a need for strengthening primary healthcare, integrating NCD services into existing health programs, and improving access to essential medicines and technologies for NCD prevention and control.
• NCD risk factors such as tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol, and air pollution are highly prevalent in India. Efforts to address NCDs require multi-sectoral collaboration and population-wide interventions to promote healthy lifestyles, reduce exposure to risk factors, and create supportive environments for health.
• India's demographic transition, characterized by an ageing population and increasing life expectancy, contributes to the rising burden of NCDs. Older adults are at higher risk of developing NCDs and often require long-term care and management, placing additional strain on healthcare resources and services.

6. The status of health insurance in India

The status of health insurance in India has been evolving rapidly in recent years, with significant growth in coverage, awareness, and innovation.  As of 2021, only around 37% of the Indian population has health insurance, with a significant gap between urban and rural areas.

Several factors contribute to the current status of health insurance in India

• The Government of India has implemented several health insurance schemes to improve access to healthcare and provide financial protection to vulnerable populations. These include schemes such as Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY), Rashtriya Swasthya Bima Yojana (RSBY), and various state-sponsored health insurance programs. These schemes aim to cover economically disadvantaged individuals and families, offering cashless treatment for a range of medical services.
• The private health insurance sector in India has experienced significant growth in recent years, driven by increasing demand for healthcare coverage and rising healthcare costs. Private health insurance companies offer a wide range of health insurance products tailored to the needs and preferences of different segments of the population. These include individual health insurance plans, family floater plans, group health insurance for employees, and specialized products for critical illness, maternity, and senior citizens.
• The coverage of health insurance in India has expanded significantly in recent years, with more individuals and families opting for health insurance coverage. Government initiatives, employer-sponsored schemes, and individual purchasing decisions have contributed to the growth in health insurance coverage across urban and rural areas. However, there are still significant gaps in coverage, especially among low-income and informal sector workers.
• Health insurance companies in India are increasingly offering innovative products and services to meet the evolving needs of consumers. This includes value-added services such as telemedicine consultations, wellness programs, health check-ups, and digital platforms for policy management and claims processing. Insurers are also leveraging technology, data analytics, and artificial intelligence to enhance customer experience, improve risk assessment, and prevent fraud.
• Despite progress, there are several challenges facing the health insurance sector in India, including low awareness, affordability issues, inadequate regulatory oversight, fraudulent practices, and the need for capacity building in insurance infrastructure and human resources. However, there are also opportunities for further expansion and improvement, including increasing coverage among underserved populations, enhancing product affordability and transparency, strengthening regulatory frameworks, and promoting innovation and competition in the sector.

7. Government health expenditure in primary, secondary, and tertiary care

Government health expenditure in primary, secondary, and tertiary care refers to the allocation of public funds towards healthcare services at different levels of the healthcare system. 

Primary Care

• Primary care includes essential healthcare services provided at the community level, typically through primary health centres (PHCs), health sub-centers, and other primary care facilities. These services focus on preventive care, health promotion, early detection, and basic treatment of common health problems.
• Government health expenditure in primary care encompasses funding for infrastructure development, staff salaries, medical supplies, equipment, preventive health programs, and outreach activities.
• Examples of primary care services funded by the government include immunization programs, maternal and child health services, family planning, nutrition programs, and communicable disease control initiatives.

Secondary Care

• Secondary care refers to specialized medical services provided by district hospitals, community health centres (CHCs), and other secondary care facilities. These services include diagnostic services, emergency care, specialist consultations, surgeries, and inpatient care for more complex health conditions.
• Government health expenditure in secondary care includes funding for the operation and maintenance of secondary care facilities, staffing of medical and paramedical personnel, medical equipment and technology, medicines and supplies, and support for specialized health programs.
• Examples of secondary care services funded by the government include obstetric care, surgical services, management of chronic diseases, diagnostic imaging, laboratory testing, and emergency medical services.

Tertiary Care

• Tertiary care refers to highly specialized medical services provided by tertiary care hospitals, medical colleges, teaching hospitals, and other advanced healthcare facilities. These services are typically delivered by specialized medical professionals, advanced medical technologies, and multidisciplinary teams.
• Government health expenditure in tertiary care includes funding for the operation and maintenance of tertiary care institutions, staffing of specialized healthcare professionals, procurement of advanced medical equipment and technology, research and training programs, and support for specialized treatment and rehabilitation services.
• Examples of tertiary care services funded by the government include organ transplantation, cancer treatment, cardiac surgery, neurosurgery, intensive care, rehabilitation services, and medical education and research.

8. How does India fare with other countries in terms of GDP expenditure of the health sector?

Accessing real-time data to make a definitive comparison is challenging, but here's some information to help you understand India's standing on health sector expenditure compared to other countries. According to the Economic Survey 2022-23, the central and state governments' budgeted expenditure on healthcare reached 2.1% of GDP in FY23.  This indicates an increase from previous years.

Global Comparison Challenges

• There can be discrepancies in how different countries define and measure health expenditure. This makes direct comparisons challenging.
• Some countries might have a lower public health expenditure but a high private health insurance penetration, leading to a higher overall health expenditure.
• World Bank Open Data provides data on health expenditure as a percentage of GDP for various countries.
• WHO Global Health Observatory offers health expenditure data by country. While it might not have the most recent information, it can be a helpful starting point for comparisons.