Healthcare Financing
Healthcare financing is being presented in the context of Universal Health Coverage. The basic reader for this topic can be found in “World Health Report 2010- Health Systems Financing- the Path to Universal Coverage”. A further elaboration of this theme is found in Joseph Kutzins paper- Health Financing for Universal Coverage and Health Systems Performance. We caution that both of these are part of the dominant discourse on health economics in the era of neo-liberalism and must be read to understand this. But then we suggest, you take a step back and read the classic of welfare economics paper, which in a sense marks the beginning of health economics viz. Kenneth Arrow’s “Uncertainty and the Welfare Economics of Medical Care“, 1963. The importance of this paper is elaborated in “Kenneth Arrow and the birth of health economics” (William Savedoff, 2004).
This thematic area has many sub-themes. As of now our collection of papers is focussed mainly on one of these sub-themes- viz. financial protection against the costs of care. This sub-theme closely overlaps with the theme of Universal Health Coverage.
Three of the papers presented here discuss this issue using the National Sample Survey Organizations surveys on morbidity and the costs of care. The first of these was “Falling Sick, Paying the Price, NSS 71st Round on Morbidity and Costs of Healthcare”, published in Economic and Political Weekly,2015. This article attracted a sharp rejoinder which was replied to by developing the argument further in the paper “NSSO 71st Round Data on Health and Beyond” EPW 2016. Then after the 75th round survey data became available, a comparison between the two rounds was published in “Invest More in Public Healthcare Facilities, What Do NSSO 71st And 75th Rounds Say?” EPW 2022.
These same data sets were used for more detailed investigation of the effectiveness of publicly funded health insurance programmes. The peer-reviewed and more widely cited paper on this is “Effectiveness of Government Strategies for Financial Protection Against Costs of Hospitalization Care in India“ A. Ranjan et al. Another useful paper using the same methodology is Utilisation and Financial Protection for Hospital Care Under Publicly Funded Health insurance In Three States in Southern India.”
We are also providing access to three papers based on primary data collection done by a research team under CS Verma, professor in Giri Institute of Development Studies, UP. These are “Social and Systemic Determinants of Utilisation of Public Healthcare Services In Uttar Pradesh.” And “Healthcare Consumption In Uttar Pradesh- Iniquitous Growth and Social Factors Contributing to Impoverishment.”
Two other papers based on primary data collection were done under the NHSRC. These include “Out-Of-Pocket and Catastrophic Health Expenditure: A Cross-Sectional Assessment from Koderma, Jharkhand Of A Rural District Of The State Of Jharkhand In India.” Another paper which was also an outcome of the same study dealt largely with OOPE and financial protection strategies in Villupuram district of Tamil Nadu: “Measuring Progress towards Universal Health Coverage: An Approach in the Indian context.” Many of the above papers are somewhat outdated because they relate to the period before PMJAY. Resources based on primary data that relate to more recent times are Samir Garg al’s papers in BMC Health Services on (i) Catastrophic health expenditure due to hospitalisation for COVID-19 treatment in India, on (ii) Household expenditure on non-Covid hospitalisation care and the role of financial protection policies in India and (iii) How much do government and households spend on an episode of hospitalisation in India?, and (iv) Comparing the average cost of outpatient care of public and for-profit private providers in India and more recently in EPW on Why Do Patients Enrolled under Ayushman Bharat Incur Medical Expenses?.
There are many papers published on the health budget each year. We begin with our paper “No Respite for Public Health- On Health Budget 2016-17.” Looking at the sharp decline in public health expenditure that had begun in these years this paper concluded with the warning “Without sounding alarmist, it would be useful to remind the ministry that chronic and sustained under-financing of public health systems over the last four years has now reached such critical levels, that there is a serious threat to health security of the nation as well as to its economic growth—not only in the long run, but also in the immediate—not only for the poor, but for everyone.” A must read for those interested in this theme. We also provide links to more papers on this same theme in the years since.
ESI and Social Insurance
We begin with linking readers to two key documents. One is the ESIC Annual Report 2023 -24. And the other is the what is known as the Standard Note on ESIC 2023 which sets out clearly the rules and protocols. These are easily accessed on the net- but we also post them here for ease of reference.
We then enclose an ILO commissioned evaluation of the ESIC as the most recent evaluation we can lay our hands on. Also linked is a descriptive report of the ESIC prepared by Dr Sundararaman in another context. Finally, we provide a link to a recent Conversation on ESIC which is a round up of all the major issues concerned.