10. Towards Universal Health Coverage? Taking Stock of Two Decades of Health Reforms in India

As part of the 2030 Agenda for Sustainable Development, all countries, including India, have committed to trying to achieve univeral health coverage (UHC) by 2030. There are three dimensions to UHC: population coverage, services coverage, and financial risk protection. The goal is to make available to 100% of the population a broad-enough range of essential health services that cover 100% of their healthcare needs and ensure that 100% of the population can receive these services without incurring health expenditure that is more than 10% of the monthly household expenditure. While UHC is a desirable goal, it poses significant challenges for low- and middle-income countries on many fronts. Over the past two decades, India has implemented a wide range of reforms in the health sector ostensibly towards making healthcare services accessible to all. This paper discusses major health financing reforms and private sector engagement in health in India from the perspective of their contribution to UHC. Based on the existing evidence, the paper argues that recent health reforms in India have made limited contributions to access with financial risk protection for socially and economically marginalised groups. Inequalities in coverage by health services have been accentuated and the less privileged bear a disproportionate burden of catastrophic health expenditures. Drawing on the experiences of LMICs in Asia, such as Thailand and Vietnam that have achieved near-universal health coverage, the paper concludes with listing much-needed reforms that are urgently needed for India to move anywhere close to UHC.