title: Assuring health coverage for all in India.
abstract: Successive Governments of India have promised to transform India's unsatisfactory health-care system, culminating in the present government's promise to expand health assurance for all. Despite substantial improvements in some health indicators in the past decade, India contributes disproportionately to the global burden of disease, with health indicators that compare unfavourably with other middle-income countries and India's regional neighbours. Large health disparities between states, between rural and urban populations, and across social classes persist. A large proportion of the population is impoverished because of high out-of-pocket health-care expenditures and suffers the adverse consequences of poor quality of care. Here we make the case not only for more resources but for a radically new architecture for India's health-care system. India needs to adopt an integrated national health-care system built around a strong public primary care system with a clearly articulated supportive role for the private and indigenous sectors. This system must address acute as well as chronic health-care needs, offer choice of care that is rational, accessible, and of good quality, support cashless service at point of delivery, and ensure accountability through governance by a robust regulatory framework. In the process, several major challenges will need to be confronted, most notably the very low levels of public expenditure; the poor regulation, rapid commercialisation of and corruption in health care; and the fragmentation of governance of health care. Most importantly, assuring universal health coverage will require the explicit acknowledgment, by government and civil society, of health care as a public good on par with education. Only a radical restructuring of the health-care system that promotes health equity and eliminates impoverishment due to out-of-pocket expenditures will assure health for all Indians by 2022--a fitting way to mark the 75th year of India's independence.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, Gurgaon, India. Electronic address: vikram.patel@lshtm.ac.uk.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Public Health Foundation of India, Gurgaon, India.
authors.forename: Rachana
authors.initials: R
authors.lastname: Parikh
authors.affiliation: Public Health Foundation of India, Gurgaon, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Nandraj
authors.affiliation: Public Health Foundation of India, Gurgaon, India; Public Health Foundation of India and Royal Norwegian Embassy Universal Health Initiative, New Delhi, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Balasubramaniam
authors.affiliation: Public Health Foundation of India, Gurgaon, India.
authors.forename: Kavita
authors.initials: K
authors.lastname: Narayan
authors.affiliation: Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Paul
authors.affiliation: Independent Researcher and Policy Analyst, New Delhi, India.
authors.forename: A K Shiva
authors.initials: AK
authors.lastname: Kumar
authors.affiliation: Sewa, Ahmedabad, India; VimoSEWA Cooperative, Ahmedabad, India; Lok Swasthya Health Cooperative, Ahmedabad, India.
authors.forename: Mirai
authors.initials: M
authors.lastname: Chatterjee
authors.affiliation: Public Health Foundation of India, Gurgaon, India; World Heart Federation, New Delhi, India.
authors.forename: K Srinath
authors.initials: KS
authors.lastname: Reddy
mesh_terms: D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration; D005102:Health Expenditures; D063005:Health Information Systems / Q000458:organization & administration / Q000592:standards; D054624:Health Status Disparities; D006280:Health Workforce / Q000592:standards / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D040361:Healthy People Programs / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007194:India; D007348:Insurance, Health; D008017:Life Expectancy; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D017149:Private Sector / Q000191:economics / Q000458:organization & administration; D017150:Public Sector / Q000191:economics / Q000458:organization & administration; D011787:Quality of Health Care; D012111:Residence Characteristics; D012423:Rural Health; D017678:Sex Distribution; D012744:Sex Ratio; D013222:State Medicine / Q000191:economics / Q000458:organization & administration; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration*; D014504:Urban Health