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INDIA How are costs contained? There are no comprehensive policies to hold down costs. Most cost-containment strategies are limited to costsharing and use of generic drugs. There is limited evidence with respect to use of cost-effectiveness assessments, monitoring for financial performance, improvement in operational efficiency, and health technology assessments. As the public health care system is financed through taxes, costs are contained in the first instance by allocations made to the health sector, which currently amount to less than 2 percent of GDP. Most government health facilities have to operate within the yearly allocated budget. Where there are public–private partnerships, government negotiates prices with private providers and reimburses accordingly. What major innovations and reforms have been introduced? A key goal of the 12th five-year plan is to move toward universal coverage to provide universal access to equitable, affordable, and quality health care, with supplementation from the private sector (MOH, 2014 and 2015a). Toward this end, the National Health Mission and its two Sub-Missions—the National Rural Health Mission and the National Urban Health Mission—was approved by the Cabinet in May 2013. The main components include health system strengthening in rural and urban areas; the Reproductive, Maternal, Newborn, Child and Adolescent Health strategy; and control of communicable and noncommunicable diseases (MOH, 2015a). A number of initiatives are being introduced with respect to quality of care, as described in the section on quality, above. An example of health system integration reform is the RSBY scheme. This scheme, now under the Ministry of Health and Family Welfare, is helping the state and central ministry move to a tax-financed, single-payer system (MOH, 2014). Reforms also have been introduced to ensure equity in resource allocation. Allocation decisions are to take into account financial ability, developmental need, and high-priority districts, targeting specific population subgroups, geographical areas, health care services, and gender-related issues. A risk equalization formula based on health care need could be developed, with built-in financial incentives for facilities providing a certified quality of care (MOH, 2014). Other initiatives being introduced include the India Newborn Action Plan, to reduce preventable newborn deaths and stillbirths; the provision of providing free drugs and diagnostic services; the aforementioned National eHealth Authority; and a new health rights bill to ensure health as a fundamental right (MOH, 2015a). The author would like to acknowledge the input provided by Elias Mossialos and the LSE editorial team for editing the previous draft. 84 The Commonwealth Fund
References INDIA Balarajan, Y., S. Selvaraj, and S. V. Subramanian (2011). Health Care and Equity in India. Lancet, Feb. 5, 2011 377(9764):505–15. CBHI (2013). National Health Profile (NHP) of India. Central Bureau of Health Intelligence. http://cbhidghs.nic.in/index2. asp?slid=1284&sublinkid=1166. Accessed Aug. 30, 2015. DGHS (2011). National Programme for the Health Care of the Elderly: Operational Guidelines. Ministry of Health and Family Welfare. http://mohfw.nic.in/index3.php?lang=1&deptid=36. Accessed Aug. 22, 2015. Forgia, G., and S. Nagpal (2012). Government-Sponsored Health Insurance in India: Are You Covered? World Bank. Gudwani, A., P. Mitra, A. Puri, and M. Vaidya (2012). India Health Care: Inspiring Possibilities, Challenging Journey. McKinsey and Co. Gyani, G. (2015). “India,” in J. Braithwaite, Y. Matsuyama, R. Mannion, and J. Johnson (eds.), Healthcare Reform, Quality and Safety: Perspectives, Participants and Prospects in 30 Countries. Ashgate Publishing Limited, England. Ministry of Health and Family Welfare (MOH) (2009). The National Health Bill (draft). Government of India. Accessed from http://www.prsindia.org/uploads/media/Draft_National_Bill.pdf on 22nd August, 2015. MOH (2011). Annual Report to the People on Health. Government of India. MOH (2012). Notification Clinical Establishment Act. Government of India. http://clinicalestablishments.nic.in/ WriteReadData/386.pdf. Accessed Aug. 22, 2015. MOH (2013). National Health Mission. Government of India. http://nrhm.gov.in/nhm/nrhm/guidelines/indian-public-healthstandards.html. Accessed Nov. 21, 2015. MOH (2014). “National Health Policy 2015” (draft). Government of India. MOH (2015a). Annual Report of Department of Health and Family Welfare for the Year of 2014–15. Government of India. MOH (2015b act). The Clinical Establishment Act, 2010. http://clinicalestablishments.nic.in/cms/Home.aspx. Accessed Aug. 22, 2015. MOH (2015c NeHA). National eHealth Authority (NeHA) (Concept Note). Government of India. http://mohfw.nic.in/showfile. php?lid=3099. Accessed Aug. 25, 2015. NABH (2006). NABH’s hospital accreditation programme. http://nabh.co/shco-standard.aspx. Accessed Nov. 21, 2015. Organisation for Economic Co-operation and Development (OECD) (2015). OECD.Stat. DOI: 10.1787/data-00285-en. Accessed Sept. 17, 2015. OECD (2014). OECD Health Statistics 2014. “How Does India Compare?” http://www.oecd.org/els/health-systems/Briefing- Note-INDIA-2014.pdf. Accessed Aug. 30, 2015. Planning Commission of India (2011). High Level Expert Group Report on Universal Health Coverage in India. Government of India. Planning Commission (2014). Report of the Expert Group to Review the Methodology for Measurement of Poverty. Government of India. Rashtriya Swathya Bima Yojna (2015). Rashtriya Swathya Bima Yojna Ministry of Labour and Employment. http://www.rsby. gov.in/about_rsby.aspx. Accessed Aug. 22, 2015. Save the Children (2013). Reducing Inequality: Learning Lessons for the Post-2015 Agenda—India Case Study. New Delhi. Thomas, V. (2009). “The National Health Bill 2009 and Afterwards.” Annals of Indian Academy of Neurolology, April–June 2009 12(2):79. Wennerholm, P., A. M. Scheutz, Y. Zaveri-Roy, and M. Wikström (2013). India’s Healthcare System—Overview and Quality Improvements. Swedish Agency for Growth Policy Analysis. World Health Organization (WHO) (2013). India Country Profile: Human Resources for Health Observatory. SERO, WHO. http://www.searo.who.int/entity/human_resources/data/india-2013.pdf?ua=1. Accessed Aug. 30, 2015. WHO (2015). Country Cooperation Strategy at a Glance: India. WHO. http://www.who.int/countryfocus/cooperation_ strategy/ccsbrief_ind_en.pdf. Accessed Aug. 16, 2015. International Profiles of Health Care Systems, 2015 85
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JANUARY 2016 2015 International Pro
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2015 International Profiles of Heal
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AUSTRALIA low-income adults, childr
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References AUSTRALIA Australian Bur
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CANADA What is covered? Services: T
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CANADA funding to 145 not-for-profi
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CANADA Organization of the Health S
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CANADA Health Council of Canada (20
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CHINA Private health insurance: Com
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Page 60 and 61: FRANCE VHI finances 13.8 percent of
Page 62 and 63: FRANCE The average income of primar
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Page 68 and 69: FRANCE Nolte, E., C. Knai, and M. M
Page 70 and 71: GERMANY There were 42 substitutive
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NORWAY Primary, preventive, and nur
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NORWAY The National System for the
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SINGAPORE Medifund is the governmen
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UNITED STATES What is covered? Serv
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UNITED STATES The Institute of Medi
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The COMMONWEALTH FUND Affordable, q
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