AMRITA SCHOOL OF DENTISTRY

1. U N I V E R S A
L H E A LT H
C A R E
Seminar
no:12
1

2. • Introduction
• History
• Monitoring and evaluation of UHC
• UHC service coverge index
• High Level of Expert Group Report on UHC in India
• Ayushman Bharat
• National Health Insurance Scheme
• Role of oral health in UHC
• Role of national digital health mission on UHC
• Universal health interface
• Initiatives of UHC
• Conclusion
• References
CONTENTS
2

3. Universal Health Coverage or UHC is defined
as “ensuring that all people have access to
needed promotive, preventive, curative and
rehabilitative health services, of sufficient
quality to be effective, while also ensuring that
people do not suffer financial hardship when
paying for these services”.
-(WHO, 2012)
INTRODUCTION
3

4. CONCEPT OF UHC
Equity in access
to health services
Quality of health
services
Financial-risk
protection
4

5. 1883- Health Insurance Bill, Germany became the first country to make nationwide health insurance mandatory.
1933- Franklin D. Roosevelt, a Democrat, funded health care program while drafting provisions to Social Security
legislation, which was eliminated from the final legislation
1948- In U. K. Enactment of the National Insurance Act in 1911 and the National Health Service (NHS)
1948- Article 25.1 of the Universal Declaration of Human Rights states right to health as an important fundamental
right.
1949 -President Harry S Truman proposed universal health care
1965- Medicare and Medicaid was created by the proposal of Lyndon B. Johnson with Social Security Act; Proposals by
Ted Kennedy, President Richard Nixon and Jimmy Carter that promoted variations of universal health care.
HISTORY
5

6. 1966- The International Convention on Economic, Social and Cultural Rights recognized "the right of
everyone to the enjoyment of the highest attainable standard of physical and mental health.
1978- Alma-Ata declaration & the vision of "health for all”
1993- An effort was made by President Bill Clinton and headed by first lady Hillary Clinton but was not
enacted into law.
2005- World Health Assembly resolution 58.33 adopted 'Universal Health Coverage’
2010- President Barack Obama and control of both houses of Congress by the Democrats led to the
passage of the Affordable Care Act (ACA), often referred to as “ObamaCare” was signed into law.
2011- High Level Expert Group Committee Report India
6

7. Role of WHO:
• UHC is firmly based on the 1948 WHO Constitution.
• WHO works with many different partners in different situations and for different purposes to advance
UHC around the world.
Some of WHO’s partnerships include:
• UHC2030
• Alliance for Health Policy and Systems Research
• P4H Social Health Protection Network
• UHC Partnership
• Primary Health-Care Performance Initiative
7

8. • To achieve SDG target 3.8 of Universal Health
Coverage for all by 2030, at least 1 billion more people
will need to have access to essential health services in
each five-year period between 2015 and 2030.
• The essence of UHC is universal access to people-
centred health system with primary care as its
foundation.
• Community-based services, health promotion, disease
prevention and immunization are key components.
2030 Agenda for SDGs
8

9. Target 3.8 - “Achieve universal health coverage, including financial risk protection, access to quality essential
health-care services and access to safe, effective, quality and affordable essential medicines and vaccines
for all”.
Two indicators to monitor target 3.8 within the SDG framework.
• The proportion of a population that can access essential quality health services (SDG 3.8.1)
• The proportion of the population that spends a large amount of household income on health (SDG
3.8.2).
The UHC service coverage index combines 16 essential health services in 4 categories :
UHC SERVICE COVERAGE INDEX (3.8)
Reproductive, maternal,
newborn and child health
• family planning
Infectious diseases
• tuberculosis treatment
Noncommunicable
diseases
• prevention and
Service capacity and
access
• basic hospital access
9

10. Method of measurement
• For each country, the most recent value for each tracer indicators is taken from WHO or other international
agencies
Preferred data sources:
• Household surveys
• Administrative data
• Special facility surveys
Expected frequency of data dissemination:
• 2-3 years
Expected frequency of data collection:
• 1-5 years
Limitations:
• Due to data limitations, not all tracer indicators used to compute the index are direct measures of service
coverage. These proxy indicators will be replaced in future years when more data become available.
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11. 11

12. 12

13. 13

14. Monitoring and evaluation framework for PHC
• This document responds to Member States’ request in resolution
WHA on primary health care for guidance to assess, track and
monitor PHC performance to accelerate progress towards UHC and
the health-related SDGs .
• The framework presented in this document are based on and support
the 14 levers of the Operational framework for primary health care.
• This document includes WHO’s Thirteenth General Programme of
work, as well as other global health system monitoring efforts.
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15. Strengthening health systems based on primary health care: accelerating progress towards UHC
and health security
15

16. Before COVID-19 struck, the world was far short of reaching the
Sustainable Goal (SDG) 3.8 targets and the goal of 1 billion more
people benefiting from UHC by 2023.
16

17. Disruptions of essential health services due to COVID-19
17

18. COVID-19 and financial protection
18

19. • Report, adopted the following definition of Universal Health
Coverage (UHC):
Ensuring equitable access for all Indian citizens, resident in
any part of the country, regardless of income level, social status,
gender, caste or religion, to affordable, accountable,
appropriate health services of assured quality (promotive,
preventive, curative and rehabilitative) as well as public health
services addressing the wider determinants of health delivered
to individuals and populations, with the government being the
guarantor and enabler, although not necessarily the only
provider, of health and related services.
-HLEG
• Constituted on October, 2010
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20. 20

21. universality;
equity;
non-exclusion and non-discrimination;
comprehensive care that is rational and of good quality;
financial protection;
protection of patients’ rights that guarantee appropriateness of
care, patient choice, portability and continuity of care;
consolidated and strengthened public health provisioning;
Principles of
UHC in
India
21

22. Health Financing and Financial Protection
Health Service Norms
Human Resources for Health
Community Participation and Citizen
Engagement
Access to Medicines, Vaccines and
Technology
Management and Institutional Reforms
THE NEW ARCHITECTURE FOR UHC
FOCUS AREAS
Human resource requirements
Access to health care services
Management reforms
Community participation
Access to medicines
Health care financing
Social determinants of health
Urban Health
Female gender
Public- private partnership
Information technology- enabled Health services
22

23. Central government and
states should increase
public expenditures on
health from the current
level of 1.2% of GDP to at
least 2.5% by the end of 12
th plan, and to at least 3%
of GDP by 2022. 23

24. 24

25. Recommended agencies:
1. National Health Regulatory and
Development Authority (NHRDA)
• The System Support Unit (SSU)
• The National Health and Medical
Facilities
• Accreditation Unit (NHMFAU)
• The Health System Evaluation
Unit (HSEU)
2. National Drug Regulatory
Authority (NDRDA)
3. National Health Promotion and
Protection Trust (NHPPT) 25

26. Ayushman Bharat
Ayushman Bharat, a flagship scheme of Government of India, was
launched as recommended by the National Health Policy 2017, to
achieve the vision of Universal Health Coverage (UHC). Ayushman
Bharat adopts two inter-related components, which are -
• Health and Wellness Centers (HWCs)
• Pradhan Mantri Jan Arogya Yojana (PM-JAY)
26

27. Arogya
Karnataka
HR Reforms
DNB, Bidding of Specialists,
filling positions - field level
functionaries
Financial
Protection
Scheme
Harmonization
Comprehensive
Primary Health Care
Health and Wellness
Centres
Free Diagnostics
E-Hospital &
Convergence of
IT platform
for continuity of
care
Free Drugs
AROGYA KARNATAKA – UNIVERSAL HEALTH COVERAGE
27

28. • The Report of the Primary Health Care Task Force,
primary health care provides valuable insights into
structure and processes that are required in health
systems to enable Comprehensive Primary Health
Care (CPHC).
• The Twelfth Five Year Plan Identified Universal Health
Coverage as a key goal and based on the
recommendations of the High- Level Expert Group
Report on UHC had called for 70% budgetary
allocation to Primary Health Care in pursuit of UHC for
India.
28

29. NATIONAL HEALTH INSURANCE SCHEMES
Rashtriya Swasthiya Bima Yojana (RSBY)
Employment State Insurance Scheme (ESIS)
Central Government Health Scheme (CGHS)
Aam Aadmi Bima Yojana (AABY)
Janashree Bima Yojana (JBY)
Universal Health Insurance Scheme (UHIS)
29

30. 1.Rashtiya Swasthiya Bima Yojana (RSBY)
• To provide health insurance coverage for Below Poverty Line (BPL) families.
• Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- for most of the
diseases that require hospitalization.
• The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of
23 million families have been enrolled as of February 2011.
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31. Unique Features of RSBY
Empowering the beneficiary
Business Model for all Stakeholders-Insurers, Hospitals,
Intermediaries and Government
Information Technology (IT) Intensive
Safe and foolproof
Portability
Cash less and Paperless transactions 31

32. 2.Employment State Insurance Scheme (ESIS)
• Employees’ State Insurance Scheme of India, is a multidimensional social security system tailored to
provide socio-economic protection to worker population and their dependants covered under the scheme.
• Applicability
• The Act is applicable to non-seasonal factories employing 10 or more persons.
• The Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatres,
road-motor transport undertakings and newspaper establishments employing 20 or more persons.
• The Scheme has been extended to Private Medical and Educational institutions employing 20 or more
persons in certain States/UTs.
• Areas covered
• States :- All the States except Manipur, Sikkim, Arunachal Pradesh and Mizoram.
• Union territories :- Delhi and Chandigarh
32

33. 3.Central Government Health Scheme (CGHS)
• Provides comprehensive health care facilities for the Central Govt. employees and pensioners and their
dependents residing in CGHS covered cities. Started in New Delhi in 1954. The medical facilities are
provided through Wellness Centres /polyclinics under all systems of medicines.
• The main components of the Scheme are:
• The dispensary services including domiciliary care
• F. W. & M.C.H. Services
• Specialists consultation facilities both at dispensary, polyclinic and hospital level including X-Ray, ECG
and Laboratory Examinations.
• Hospitalization
• Organization for the purchase, storage, distribution and supply of medicines and other requirements
• Health Education to beneficiaries
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34. 34

35. 4. Aam Aadmi Bima Yojana(AABY)
• Aam admi bima yojana, a Social Security Scheme for rural landless household was launched on 2nd
October, 2007.
• A separate fund called "Aam Admi Bima Yojana Premium Fund" has been set up by Central Govt. to pay the
Govt. contribution. Fund is maintained by LIC.
6.Universal Health Insurance Scheme (UHIS)
• The four public sector general insurance companies have been implementing Universal Health Insurance
Scheme for improving the access of health care to poor families.
• The Universal Health Insurance Scheme (UHIS) has been redesigned targeting only the BPL families.
• The Universal Health Insurance Scheme was launched on a countrywide basis in July 2003 with an
objective to provide health care to poorest section of the society.
35

36. Government Sponsored Socially Oriented Insurance Schemes
• Pradhan Mantri Jeevan Jyoti Bima Yojana(PMJJBY)
• Pradhan Mantri Suraksha Bima Yojana(PMSBY)
• Life Cover under Pradhan Mantri Jan Dhan Yojana (PMJDY)
• Varishtha Pension Bima Yojana
• Pradhan Mantri Fasal Bima Yojana(PMFBY)
• Pradhan Mantri Vaya Vandana Yojana(PMVVY)
• Restructured Weather Based Crop Insurance Scheme
(RWBCIS)
36

37. Megha Health Insurance Scheme (MHIS)
• The Megha Health Insurance Scheme (RSBY +
UHIS) was launched on 15th December, 2012
by then Chief Minister Dr Mukul Sangma, in
convergence with Rashtriya Swasthiya Bima
Yojana (RSBY).
• The objective to provide financial aid to all the
citizens of the state at the time hospitalization
and reduce the out-of-pocket expenses of the
residents of the State (excluding state and
central government employees)
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38. 38

39. • A majority of the world’s extreme poor people resided in low income countries,
until India moved from the low income group to the lower-middle income group
in 2007.
• China and India, due to their population size and economic development, have
had an enormous influence on global patterns of poverty and health aid.
39

40. Government Subsidized health insurance schemes:
• India has multiple types of health insurance schemes.
• They can broadly be bucketed into three categories
based on financing source (Government tax revenue or
contribution based), target group (e.g., formal sector
workers), and compulsory versus voluntary nature of
the scheme.
• These schemes provide fully or partially subsidized
insurance coverage to specific targeted segments of the
population.
• Social Health Insurance (SHI) Schemes
• Private voluntary health insurance (PVHI)
40

41. 41

42. HEALTH INSURANCE / ASSURANCE IN INDIA: NEED AND LANDSCAPE
• Low financial protection leads to high out-of-pocket expenditure (OOPE).
• Pre-payment through health insurance emerges as an important tool for risk-pooling and safeguarding
against catastrophic (and often impoverishing) health expenditure.
• Pre-paid pooled funds can also improve the efficiency of healthcare provision.
42

43. RECOMMENDATIONS AND PATHWAYS TO INCREASING HEALTH INSURANCE COVERAGE
43

44. Aarogya Sanjeevani Health Insurance Plan
• The Insurance Regulatory Development Authority
of India (IRDAI) launched a standardized health
insurance product – Arogya Sanjeevani – in April
2020.
• The sum insured is flexible – varying between Rs.
50,000 to Rs. 10 lakhs – based on the needs of
the individual, or the family.
Designing a low-cost comprehensive health insurance product for the missing middle:
44

45. Role of Oral Health in UHC
• FDI welcomed the commitment to strengthen oral health in the United Nations (UN)
Political Declaration on Universal Health Coverage (UHC), which was officially
adopted by world leaders at the UN High-Level Meeting on UHC on September 23 in
New York.
• WHO’s 13th Global Programme of Work 2019–2023 with its focus on UHC can help
move the global oral health agenda forward.
• More than half of the
world’s population (3.5
billion) suffer from
untreated oral diseases,
which can result in pain,
infection, tooth loss and
loss of productivity.
• In 2010 direct treatment
costs due to oral diseases
worldwide were estimated
at US$298 billion yearly,
corresponding to an
average of 4.6% of global
health expenditure
FACTS
45

46. Vision
To create a National Digital Health Eco-system that
supports universal health coverage in an efficient,
accessible, inclusive, affordable, timely and safe manner,
through provision of a wide-range of data, information and
infrastructure services, duly leveraging open,
interoperable, standards-based digital systems, and
ensuring the security, confidentiality and privacy of health-
related personal information.
ROLE OF NATIONAL DIGITAL HEALTH MISSION ON UHC
46

47. UNIVERSAL HEALTH INTERFACE
47

48. Universal health interface benefits:
48

49. Scope of
NDHM
Health and
Well-being
for ALL;
Health and
Well-being
at ALL
Ages;
Universal
Health
Coverage;
Citizen-
centric
Services;
Quality of
Care;
Accountabil
ity for
Performanc
e;
Efficiency
and
Effectivene
ss in
delivery of
services;
Creation of
a holistic
and
comprehen
sive health
eco-
system.
Methods & Instruments
recommended by NDHB
• Federated Architecture
• Universal Health Id (UHID)
• Electronic Health Records
(EHR)
• Metadata & Data Standards
(MDDS)
• Health Informatics Standards
• Registries for NCDs
• Directories of Providers,
Professionals and Para-
medicals
• Legislation and Regulations on
Data Management, with focus
on Privacy and Security
• Data Analytics
49

50. 50

51. 51

52. UMID Card by Indian Railways
Features of the UMID cards :
• Electronic Platform
• Card Free System
• Change of Health Units
• Automatic Generation of OPD
Slips
• Hospital-wise Debits and Credits
• Hassle-free Usage
• Both Web and Mobile Application
• Applicability and Scalability
• Continuous Validation
Mechanism
• CSTE Scheme Hospitals
52

53. 53

54. • Universal Health Services, Inc. (UHS) is one of the largest and most respected providers of hospital and
healthcare services in the US dedicated to improving people’s lives and transforming the delivery of
healthcare.
• Through its subsidiaries, the company operates 28 Acute Care hospitals, 335 Behavioral Health inpatient
facilities, and 40 outpatient facilities and ambulatory care centers in 39 states in the U.S., Washington,
D.C., Puerto Rico and the United Kingdom.
54

55. Physicians for a National Health Program is a single issue organization advocating a universal,
comprehensive single-payer national health program.
55

56. CONCLUSION
56

57. REFERENCES
 https://www.who.int/health-topics/universal-health-coverage#tab=tab_1
 https://www.who.int/publications/i?healthtopics=6b21a1ad-3bdd-44ba-a311-4abafa4efef3
 https://www.niti.gov.in/long-road-universal-health-
coverage#:~:text=India%20is%20committed%20to%20achieving,per%20cent%20of%20the%20population.
 https://www.nhp.gov.in/universal-health-coverage_pg
 https://uiic.co.in/en/taxonomy/term/1283
 https://www.etrainstatus.com/railnews/umid-card-by-indian-railways/ https://www.who.int/news-room/fact-
sheets/detail/universal-health-coverage-(uhc)
 https://www.commonwealthfund.org/international-health-policy-center/countries/india
 https://gh.bmj.com/content/5/9/e003801
 https://www.bankbazaar.com/health-insurance/universal-health-insurance-scheme.html
 https://journals.sagepub.com/doi/abs/10.1177/0971721820912920?journalCode=stsa
 https://www.nhp.gov.in/national-health-insurance-schemes_pg
57

58.  https://nha.gov.in/PM-JAY
 https://financialservices.gov.in/insurance-divisions/Government-Sponsored-Socially-Oriented-Insurance-
Schemes/Pradhan-Mantri-Suraksha-Bima-Yojana(PMSBY)
 https://iphindia.org/implementation-indias-national-health-insurance-scheme-experience-field/
 https://www.healthindiatpa.com/rsby/index.aspx
 https://www.uhs.com/
 https://pnhp.org/
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541093/
 https://mhis.org.in/
 https://www.researchgate.net/publication/274313651_Universal_Health_Coverage_for_Inclusive_and_Sustain
able_Development_A_Synthesis_of_11_Country_Case_Studies
 https://www.ncbi.nlm.nih.gov/books/NBK373408/
 https://in.one.un.org/task-teams/universal-health-coverage/ 58

59. THANK YOU
59