IntroductionTo achieve universal health coverage, the Government of India has introduced Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB - PMJAY), a large tax-funded national health insurance scheme for the provision of secondary and tertiary care services in public and private hospitals. AB - PMJAY reimburses care for 1573 health benefit packages (HBPs). HBPs are designed to cover the treatment of diseases/conditions with high incidence/prevalence or which contribute to high out-of-pocket expenditure. However, there is a dearth of reference cost data against which provider payment rates can be assessed.Methods and analysisThe CHSI (Cost of Health Services in India) study will collect cost data from 13 Indian states covering 52 public and 40 private hospitals, using a mixed economic costing methodology (top-down and bottom-up), to generate unit costs for the HBPs. States will be sampled to capture economic status, development indicators and health service utilisation heteroge...

India has announced the ambitious program to transform the current primary healthcare facilities to health and wellness centres (HWCs) for provision of comprehensive primary health care (CPHC). We undertook this study to assess the cost of this scale-up to inform decisions on budgetary allocation, as well as to set the norms for capitation-based payments. The scale-up cost was assessed from both a financial and an economic perspective. Primary data on resources used to provide services in 93 sub-health centres (SHCs) and 38 primary health care centres (PHCs) were obtained from the National Health System Cost Database. The cost of additional infrastructure and human resources was assessed against the normative guidelines of Indian Public Health Standards and the HWC. The cost of other inputs (drugs, consumables, etc.) was determined by undertaking the need estimation based on disease burden or programme guidelines, standard treatment guidelines and extent and pattern of care utilizat...

With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health faci...

The issue of financing health care has assumed greater significance in the developing world, mainly due to changing role of the state in providing health care. This article examines the levels, trends and patterns of public expenditure on health during 1995 to 2006 in India, both at the national and state levels. We find that public expenditure on health as a proportion of GDP has remained stagnant over the years, and revenue expenditure accounting for the larger share. Among the states, the relatively poor ones were found to be spending more on health, both per capita and as a proportion of GSDP, compared to the richer states. It was seen that expenditure on health by the state had not grown adequately along the path of overall economic prosperity, and private out-of-pocket expenditure seemed to be on the rise. The article cites a few alternative health financing strategies based on recent initiatives across the country, which needs to be reviewed with true intent, aiming equitable, unbiased and universal access to health care in the years to come.

Universal health coverage (UHC) is the means to provide accessible and appropriate health services to all citizens without financial hardships. India, an emerging economy with demographic window of opportunity has been facing dual burden of diseases in midst of multiple transitions. Health situation in the country despite quantum improvements in recent past has enormous challenges with urban-rural and interstate differentials. Successful national programs exist, but lack of ability to provide and sustain UHC. Achieving UHC require sustained mechanisms for health financing and to provide financial protection through national health packages. There is a need to ensure universal access to medicines, vaccines and emerging technologies along with development of Human Resources for Health (HRH).Health service, management, and institutional reforms are required along with enhanced focus on social determinants of health and citizen engagement. UHC is the way for providing health assurance and enlarging scope of primary health care to nook and corners of the country. Methodology of the study includes secondary data through journals and data reviews through various data published on websites (National and international).The terms used for searching were social health insurance, health insurance and spending on health by both developed and developing countries. Data sources include High level expert group report on UHC in India by Planning Commission of India, WHO reports ,Mc Kinsey report on UHC were used to know the various health insurance schemes in various countries.

The paper explores the trends, composition, and incidence of out-of-pocket health expenditure (OOPHE) in India, which has been the predominant means of financing its health care needs. Unit-level data from the National Sample Survey on Household Consumer Expenditure for the years 1993–94, 2004–05, and 2011–12 are used. Results show that the burden of OOPHE has increased steadily over time, but more for the lower economic quintiles. Drugs remain the major component of OOPHE, but their share has declined over the years. Expenditure on diagnostics and non-medical items increased sharply, especially for in-patient care. The latter period, i.e., 2004–05 to 2011–12, has been relatively more regressive. Higher growth of diagnostics and other expenditures, especially at institutions, points toward the possibility of supplier-induced demand. The income effect may also have had some role in the increase in the share of OOPS in the total expenditure of households. Any design of a universal health coverage scheme must take these results into consideration—not only in the specifics of a package, but also around regulation and quality of health services.

Health is the basic requirement for socioeconomic , political and cultural development of any society. The government wants to make certain effort for enhancing the well-being of the individual. But due to certain reason it becomes unsuccessful. The most predominant reason is the introduction of privatisation which excludes the role of government in every spare. The services which earlier provided by government now its trends become change. Privatizations touch every aspect but among them the health care got much affected. The main aim of privatization is surplus value. It equates quality with cost. The privatization of health care creates inequalities in healthcare between the countries and within the countries. Privatisation leads to steep hike in health expenditures, increased medical cost, and cost of drugs, medical consultations, medical tests and hospitalisation. It also enlarged the inappropriate competition in the market, this is not because to earn but how to earn more than others. These steep hikes in health expenditure create hindrance among the low-income groups and push them in a vicious circle of poverty. The main aim of this paper was to examine the privatization of healthcare and burden of health expenditure on households. It also Explore the impact of privatization on the quality of care. This paper is primarily based on secondary data. The existing literature revealed that India ranks third in out-of-pocket expenditure on health and almost 60% of total expenditure is paid by the common man and about 3.2% Indians fall below the poverty line due to huge medical bills with about 70% spending their entire saving on healthcare and purchasing drugs. The reviewed data showed that medicines account for 20-30% of global health spending, slightly more in low-and middle-income countries, and, therefore, constitute a major part of the budget of whoever is paying for health services. The finding of this paper exposed that out of the total private medical expenditure, around 72 per cent in rural and 68 per cent in urban areas was made for purchasing "medicine" for non-hospitalised treatment. Rural households primarily depended on their "household income/savings" (68%) and on "borrowings" (25%), the urban households relied much more on their "income/saving" (75%) for financing expenditure on hospitalisation, than on "borrowings" (only 18%) The pivotal problem in healthcare sector is high cost of drugs/medicine and recommending high prized non-generic medicine (NSSO, 2O14).