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PLOS ONE  2012 

The Cost of Universal Health Care in India: A Model Based Estimate

DOI: 10.1371/journal.pone.0030362

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Abstract:

Introduction As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. Methods We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. Results We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18–73) per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%–6.8%) of the GDP for universalizing health care services. Conclusion The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

References

[1]  Moody A (2011) Moody's pegs India's economic growth at 7.5–8% in FY12. Economic Times. New York.
[2]  UNDP (2011) Human Development Report 2010. New York: United Nations Development Fund.
[3]  Suryanarayana M, Agrawal A, Prabhu K (2011) Inequality adjusted Human Development Index for India's States 2011. New Delhi: United Nations Devlopment Fund.
[4]  Balarajan Y, Selvaraj S, Subramanian SV (2011) Health care and equity in India. Lancet 377: 505–515.
[5]  Baru M, Acharya A, Acharya S, Shiva Kumar A, Nagraj K (2010) Inequities in Access to Health Services in India: Caste, Class and Region. Economic and Political Weekly XLV: 49–58.
[6]  NSSO (2006) Morbidity, Health Care and Condition of the Aged. New Delhi: Ministry of Statistics and Program Implementation, Government of India.
[7]  Prinja S, Kanavos P, Kumar R (2011) Inequities in Health Care Utilization: Role of Public Sector in Universalizing Health Care. Indian J Med Res. Forthcoming.
[8]  van Doorslaer E, O'Donnell O (2005) Paying out-of-pocket for health care in Asia: catastrophic and poverty impact. Erasmus University, Rotterdam and IPS, Colombo.
[9]  MOHFW (2005) National Health Accounts India. New Delhi: National Health Accounts Cell, Ministry of Health and Family Welfare, Government of India.
[10]  NSSO (2006) Morbidity, Health Care and the Condition of the Aged. New Delhi: National Sample Survey Organization, Ministry of Statistics and Programme Implementation.
[11]  van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, et al. (2006) Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet 368: 1357–1364.
[12]  Hammer J, Aiyar Y, Samji S (2007) Understanding government failure in public health services. Economic and Political Weekly 42: 4049–4059.
[13]  Gupta I, Dasgupta P (2000) Health-seeking behaviour in urban Delhi: an exploratory study. World Health and Population 3:
[14]  Levesque JF, Haddad S, Narayana D, Fournier P (2007) Affording what's free and paying for choice: comparing the cost of public and private hospitalizations in urban Kerala. Int J Health Plann Manage 22: 159–174.
[15]  Sengupta A, Nundy S (2005) The private sector in India. British Medical Journal 331: 1157–1158.
[16]  Rane W (1996) Analysis of drug prices, 1980–1995. Economic and Political Weekly August 24: 2331–2980.
[17]  Reddy KS, Patel V, Jha P, Paul VK, Kumar AK, et al. (2011) Towards achievement of universal health care in India by 2020: a call to action. Lancet 377: 760–768.
[18]  MOHFW (2009) The National Health Bill 2009. New Delhi: Ministry of Health and Family Welfare. Available: http://mohfw.nic.in/NRHM/Draft_Health_Bi?ll/General/Draft_National_Bill.pdf. Accessed Sep 25, 2011.
[19]  WHO (2010) World Health Report. Geneva: World Health Organization.
[20]  AFMC (2007) Standard Treatment Guidelines: Medical Management and Costing of Select Conditions. New Delhi: Armed Forces Medical College in Collaboration with Ministry of Health and Family Welfare Government of India and WHO India Country Office.
[21]  Mahal A, Fan V (2011) Achieving Universal health Coverage in India: An Assessment of the Policy Challenge. Melbourne: Monash University School of Public Health and Preventive Medicine and Harvard School of Public Health.
[22]  MOHFW (2007) Indian Public Health Standards for 201 to 300 Bedded District Hospitals: Guidelines (January 2007). New Delhi: Ministry of Health and Family Welfare. Government of India. Accessed from http://mohfw.nic.in/nrhm/Documents/IPHS_?for_201_to_300_bedded_with_Comments_of_S?ub_group.pdf on January 18, 2011.
[23]  Gupta M (2010) Rate Contract of Consumables and Equipments for PGIMER Chandigarh. Chandigarh.
[24]  WHO (2005) CHOosing interventions that are Cost-Effective (WHO-CHOICE): Results for unit costs for patient services for 14 GBD Regions. Geneva: World Health Organization.
[25]  MOHFW (2005) National Commission on Macroeconomics and Health. New Delhi: Ministry of Health and Family Welfare Government of India, and World Health Organization India. Available: http://whoindia.org/en/Section102/Sectio?n201_886.htm.
[26]  Health Do (2010) Surgery Care Package. Panchkula: Haryana Health Department.
[27]  Bank W (2010) World Development Indicators. Washington DC: World Bank. Available: http://databank.worldbank.org/ddp/home.d?o?Step=3&id=4. Accessed 20th Jaunary, 2011.
[28]  MOHFW (2009) National Health Accounts India 2004–05. New Delhi: National Health Accounts Cell, Ministry of Health and Family Welfare, Government of India.
[29]  Peters D, Yazbeck A, Ramana G, Pritchett L, Wagstaff A (2002) Better Health Systems for India's Poor. New Delhi: The World Bank. pp. 233–265.
[30]  MOHFW (2005) Background Papers: Burden of Disease in India. New Delhi: Ministry of Health and Family Welfare Government of India, World Health Organization India. Available: http://whoindia.org/en/Section102/Sectio?n201_888.htm.
[31]  Srivastava NM, Awasthi S, Agarwal GG (2009) Care-seeking behavior and out-of-pocket expenditure for sick newborns among urban poor in Lucknow, northern India: a prospective follow-up study. BMC Health Serv Res 9: 61.
[32]  Singh M, Vaishya S, Gupta S, Mehta VS (2006) Economics of head injuries. Neurol India 54: 78–80.
[33]  Sur D, Chatterjee S, Riewpaiboon A, Manna B, Kanungo S, et al. (2009) Treatment cost for typhoid fever at two hospitals in Kolkata, India. J Health Popul Nutr 27: 725–732.
[34]  Mathur N, Kedia G, Trivedi A (2010) A comparative study to analyze the cost of curative care at primary health center in ahmedabad. Indian J Community Med 35: 153–158.
[35]  Dror DM, van Putten-Rademaker O, Koren R (2008) Cost of illness: evidence from a study in five resource-poor locations in India. Indian J Med Res 127: 347–361.
[36]  Wagstaff A, van Doorslaer E, van der Burg H, Calonge S, Christiansen T, et al. (1999) Equity in the finance of health care: some further international comparisons. J Health Econ 18: 263–290.
[37]  Akerlof G (1970) The markets for “Lemons”: Quality uncertainty and market mechanism. Quarterly Journal of Economics 84: 488–500.
[38]  Chollet D, Lewis M (1997) Private Insurance: Principles and Practice. Washington, DC: World Bank.
[39]  GOI (2004) National Common Minimum Program of the Government of India. New Delhi: Government of India . Available: http://pmindia.nic.in/cmp.pdf. Accessed 20th January 2011.
[40]  MOHFW (2006) Report of the Working Group on Health Care Financing including Health Insurance for the 11th Five Year Plan. New Delhi: Ministry of Health and Family Welfare, Government of India. Available: http://planningcommission.nic.in/aboutus?/committee/wrkgrp11/wg11_rphfw3.pdf. Accessed 20th January, 2011.
[41]  Berman P, Ahuja R, Tandon A, Sparkes S, Gottret P (2010) Government Health Financing in India: Challenges in Achieving Ambitious Goals. Washington, DC: World Bank Human Nutrition and Population Discussion Paper 59886.
[42]  MOF (2009) Fiscal Challenge. New Delhi: Ministry of Finance, Government of India . Available: http://finmin.nic.in/downloads/reports/f?rbm/2.pdf.
[43]  Palacios R (2010) A new approach to providing health insurance to the poor in India: The early experience of Rashtriya Swasthya Bima Yojna. New Delhi: Social Protection, World Bank . Available: http://www.rsby.gov.in/Documents.aspx?ID?=14. Accessed 10th Nov 2010.
[44]  Tancharoensathien V, Prakonsai P, Limwattananon S (2006) Achieving universal coverage in Thailand: what lessons do we learn? Paper prepared for the Health Systems Knowledge Network of the WHO Commission on Social Determinants of Health. Geneva: WHO.
[45]  Hammer J, Aiyar Y, Samji S (2007) Understanding government failure in public health services. Economic and Political Weekly 42: 4049–4059.
[46]  Frenk JA New Vision for Health Systems in the 21st Century: Investing in People; 2011. Washington, DC: World Bank.
[47]  Le Grand J (2003) Motivation, Agency and Public Policy: Of Knights and Knaves, Pawns and Queens. New York: Oxford University Press.
[48]  MOHFW (2005) National Rural Health Mission: Implemenatation Guidelines. New Delhi: Ministry of Health and Family Welfare, Government of India.
[49]  Hotchkiss DR, Jacobalis S (1999) Indonesian heath care and the economic crisis: is managed care the needed reform? Health Policy 46: 195–216.

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