State led innovations for achieving universal health coverage in a low resource setting Odisha, India: opportunities and challenges
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20211755Keywords:
Biju swasthya kalyan yojana, Publicly funded health insurance, Financial protection, Universal health coverageAbstract
Background: Odisha, a developing state of India, has introduced an innovative scheme known as Biju Swasthya Kalyan Yojana (BSKY), which aims at providing free health care to all the people. This paper examines the scope, key features, challenges and potentiality of BSKY to achieve universal health coverage (UHC) in Odisha.
Methods: We reviewed policy documents and conducted qualitative interviews with key state government officials and other stakeholders to understand implement processes and constraints.
Results: The scheme intends to provide free health care to all people in public health care institutions and additionally, 71 lakh poor households can avail health care services from the empanelled private hospitals with financial coverage up to 5 lakhs per family and women members up to 10 lakhs annually. This is implemented in assurance mode by merging state-run schemes- Rashtriya Swasthya Bima Yojana (RSBY), Biju Krushak Kalyan Yojana (BKKY) and Odisha State treatment fund (OSTF). The implementing agency is introducing several measures to control unnecessary health care utilisation and cost. Gate keeping mechanism and reserved packages by public hospital are major initiatives in this direction. Further, efforts to settle claims on time and IT related challenges are teething problems of the scheme. The findings further suggest that public expenditure on health stands at 1.3% of GSDP and inadequate human resources and health infrastructure are affecting service delivery.
Conclusions: Achieving UHC with such a low public spending on health and different service delivery constraints looks ambitious. Odisha may learn from other countries to implement UHC phase wise.
References
Global Monitoring Report on Financial Protection in Health, World Health Organisation; 2019. https://www.who.int/healthinfo/universal_health_coverage/report/fp_gmr_2019.pdf?ua=1. Accessed on 20th December, 2020.
Cotlear D, Nagpal S, Smith O, Tondon ARC. How 24 Developing Countries Are Implementing Universal Health Coverage Reforms from the Bottom Up. World Bank Group; 2015. http://documents.worldbank.org/curated/en/936881467992465464/pdf/99455-PUB- Box393200B-OUO-9-PUBDATE-9-28-15-DOI-10-1596-978-1-4648-0610-0-EPI- 210610.pdf. Accessed on 18th June, 2020.
Sumriddetchkajorn K, Shimazaki K, Ono T, Kusaba T, Sato K, Kobayashi N. Universal health coverage and primary care, Thailand. Bull World Health Organ. 2019;97(6):415- 422.
Thaiprayoon S, Wibulpolprasert S. Political and Policy Lessons from Thailand ’ s UHC Experience. Obs Res Found. 2017;(174). Available at: https://www.orfonline.org/research/political- policy-lessons-thailand-uhc-experience/. Accessed June 14, 2020.
Massuda A, Hone T, Leles FAG, de Castro MC, Atun R. The Brazilian health system at crossroads: progress, crisis and resilience. BMJ Glob Heal. 2018;3(4):e000829.
Drain PK, Barry M. Fifty Years of U.S. Embargo: Cuba’s Health Outcomes and Lessons. Science (80). 2010;328(5978):572-573.
National Health Accounts Estimates for India-2016-2017; 2018. http://nhsrcindia.org/category-detail/national-health-accounts/ODU. Accessed on 18th June, 2020.
VanDoorslaer E, Masseria C, Koolman X. Inequalities in access to medical care by income in developed countries. CMAJ. 2006;174(2):177-183.
Garg CC, Karan AK. Reducing out-of-pocket expenditures to reduce poverty: A disaggregated analysis at rural-urban and state level in India. Health Policy Plan. 2009;24(2):116-128.
Selvaraj S, Farooqui HH, Karan A. Quantifying the financial burden of households’ out- of-pocket payments on medicines in India: a repeated cross-sectional analysis of National Sample Survey data, 1994-2014. BMJ Open. 2018;8(5):e018020.
Selvaraj S, Karan AK. Why publicly-financed health insurance schemes are ineffective in providing financial risk protection. Econ Polit Wkly. 2012;47(11):60-68.
Budget Speech 2018-19. 2018. Available at: https://www.indiabudget.gov.in/budget2018-2019/ub2018-19/bs/bs.pdf. Accessed on 18th June, 2020.
National Health Mission, Department of Health & Family Welfare, Odisha G of. Biju Swasthya Kalyan Yojana. Available at: http://www.nrhmorissa. gov.in/writereaddata/Upload/Documents/BSKY.pdf. Accessed on 18th June, 2020.
Odisha Economic Survey 2018-19. 2020. Available at: https://pc.odisha.gov.in/Download/Economic_ Survey_2018-19.pdf. Accessed on 18th June, 2020.
Special bulletin on maternal mortality in India 2016-18.; 2020. Available at: https://censusindia.gov. in/vital_statistics/SRS_Bulletins/MMR Bulletin 2016-18.pdf. Accessed on 18th June, 2020.
National family health survey (nfhs-4) 2015-16 India; 2017. Available at: http ://www.rchiips.org/nfhs. Accessed on 18th June, 2020.
NSS 75th Round- Key Indicators of Social Consumption in India: Health.; 2019. http://www.mospi.gov.in/sites/default/files/publication_reports/KI_Health_75th_Final.pdf. Accessed on 18th June, 2020.
Rout SK. Public Healthcare Systems in Odisha- A Brief Review. 2017.
Karan A, Negandhi H, Nair R, Sharma A, Tiwari R, Zodpey S. Size, composition and distribution of human resource for health in India: new estimates using National Sample Survey and Registry data. BMJ Open. 2019;9(4):e025979.
Rout. Odisha State health Accounts 2013-14. 2016.
Directorate of Agriculture and Food Production, Odisha G of. Biju Krushak Kalyan Yojana (BKKY). https://bkky.nic.in/. Accessed on 18th June, 2020.
Panda B, Rout HS. Extent of use of the government sponsored health insurance schemes: evidence from rural Odisha. Indian. J Econ Dev. 2018;6(10).
Patel G, Patel K. Rastriya swasthya bima yojana and health equity: user experiences and reflections from Odisha. In: BMJ Global Health. BMJ. 2016;1:A19.2-A20.
Pradhan Mantri Jan Arogya Yojana (PM-JAY). Official Website Ayusham Bharat Yojana. National Health Authority. Available at: https://pmjay.gov.in. Accessed on 18th June, 2020.
Odisha Economic Survey of 2019-20. Available at: https://budget.odisha.gov.in/economic-survey. Accessed on 18th June, 2020.
World Health Statistics 2019 Monitoring Health for the SDGs. 2019. Available at: ttps://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf?ua=1. Accessed on 18th June, 2020.
The Global Push for Universal Health Coverage, World Health Organization. 2014;1-2. Available at: https://www.who.int/health_financing/GlobalPushforUHC_final_11Jul14-1.pdf. Accessed on 18th June, 2020.