New Delhi: The government’s aim to provide Universal Health Coverage (UHC) to all citizens by 2022 seems a distant dream with the majority of people losing faith in the quality of services at government hospitals and less than a third of households being insured to avail medical facilities in the private sector.

The glaring statistics are revealed in the recently released National Family Health Survey (NFHS-4) by the ministry of health and family welfare.

The survey reported that more than 55% of households in India do not generally seek health care from the public sector.

“Private health sector is the primary source of health care in urban areas (56%) and also in rural areas (49%). The most commonly reported reason for not using government health facilities at the national level is the poor quality of care reported by 48% of households that do not generally use government facilities,” the report said.

“The second most commonly reported reason is that no government facility is nearby, reported by 45% of households followed by the long waiting time at government facilities (41%),” it said.

The survey findings highlighted that when household members get sick, they are more likely to seek care in the private sector such as private doctors and clinics.

The hefty costs of private hospitals are born by the families pushing them towards out of pocket expenditure as majority of population is not covered by any health insurance.

“Health insurance coverage in India is far from satisfactory. Less than one-third (29%) of households have at least one usual member covered under health insurance or health scheme. Only 20% of women age 15-49 and 23% of men age 15-49 are covered by health insurance or a health scheme,” the survey report said.

“Half of those with insurance are covered by a state health insurance scheme and more than one-third are covered by Rashtriya Swasthya Bima Yojana (RSBY). Only 4% of women and 3-5% of men are covered by the Employee State Insurance Scheme (ESIS) or the Central Government Health Scheme (CGHS),” it said.

The use of government health facilities is highest in Uttar Pradesh (80%) and Bihar (78%) and lowest in Tripura (9%), the Andaman & Nicobar Islands (3%), and Lakshadweep (less than 1%). The highest proportion of households covered under health insurance or a health scheme is found in Andhra Pradesh (75%) and the lowest coverage (less than 5%) is in Lakshadweep, Manipur, and Jammu & Kashmir. 

“The major reason for the low penetration of health insurance is that it is currently optional. Also, most of the people opting for health insurance have some pre-existing illnesses leading to a high claims ratio being prevalent in the health insurance business which makes it difficult for health insurers to sustain their operations,” said Arvind Lal, President, NATHEALTH, an inclusive Institution that has representation of small and medium hospitals and nursing homes said.

“Government could explore making health insurance coverage mandatory for all citizens in a phased manner, initially covering the organised sector. Apart from enabling universal access to healthcare, this move would also meet the urgent need for augmenting healthcare capacity creation in the country. Increase in quantum of deduction towards payment of medical insurance premium as it considers the present annual deduction limit of Rs15,000 inadequate to push health insurance schemes. Accordingly, it should be enhanced to Rs50,000 for self and family and the current annual limit of Rs20,000 in respect of dependent parents needs to be enhanced to Rs50,000,” he said.

The ministry of health and family welfare has been promoting the public private partnership (PPP) model for effective delivery of healthcare. “It is critical that all stakeholders—the public, government and the private sector come together now to create a partnership of trust. Several approaches in combination can be used for this—in PPP models, or purely by incentivizing the private sector with carefully structured tax benefits,” said Suneeta Reddy, MD, Apollo Hospitals.

“We urge the government to adopt Universal Health Insurance at viable rates for all players, and to incentivize the consumers through higher tax deductions for healthcare expenditure and insurance payments,” she said.