Table 1. Feasibility* of universalizing health care using a model of public and private sector delivery in India.
Feasibility Criteria | Current Context/Proposed mechanism for provision of universal health care in India | Conclusion | Source | |
Consumer: | ||||
Willing to pay premium | Sizable population in India lacks willingness to pay and thus Government needs to commit the cost of universal health care. | Favourable | ||
Government: | ||||
Willing to involve private sector in delivery of health care. | Government has shown increasing commitment and willingness to involve private sector in delivery of health care through different schemes. | Favourable | [48] | |
Willing to administer hospital autonomy. | Through establishment of Rogi Kalyan Samitis (RKS), Government has devolved some administrative and financial powers to autonomous institutional bodies. | Favourable | [48] | |
Willing to charge higher user fees in hospitals. | Fixing user fees at optimal levels (to be paid by government), will create revenues for public sector hospitals which can then be used to improve quality of services by incentives and compete with private sector. | Favourable | ||
Ability to manage funds. | Insurer-manager models have been successfully tried (in RSBY, Aarogyashri and ESIS), however will require further strengthening for creating a national health fund. | Requires strengthening | ||
Ensure mandatory population participation to avoid adverse selection. | Our proposed model requires coverage of an entire geographic population hence it minimizes adverse selection possibility. | Favourable | [43] | |
Estimation of cost of care. | The present study estimates cost of care. These estimates can be further refined by better availability of cost and disease burden data and through yardstick competition principle. | Requires further strengthening | ||
Private Sector: | ||||
Profitable for private sector participation. | The current estimates of cost and payments have taken into account the salary structures of private sector, and provision of care with standard protocols; and hence should be acceptable to private sector. | Favourable | ||
Organizations for fund management: | ||||
Capacity development. | Will require strengthening for monitoring capacity and establishment of supportive legislations for smooth implementation | Requires strengthening |
*Feasibility evaluation matrix adapted from Hotchkiss D et al (1999) [49].