Forgone Care: The Blindspot of Our Health System

Care forgone in the early stages of diseases inflicts high health and financial burdens later on. Primary healthcare services must be strengthened for early detection and efficient referrals

- K SRINATH REDDY

Universal health coverage (UHC) is a major target of the sustainable development goals adopted by the UN and intended to be accomplished by all member states by 2030. India, a signatory to the goals, proclaimed her commitment to UHC in the National Health Policy of 2017.

Though many countries are not on track to achieve this goal by 2030, Ayushman Bharat initiatives provide India a unified framework to move towards the goal. These include strengthening of primary care, progressive expansion of public-funded health insurance schemes steered by the central and state governments, expansion of the care infrastructure and a pluripotent digital health system that amplifies the efficiency of health services and integrates disease surveillance systems.

Two metrics used for assessing progress towards UHC are degrees of 'financial protection' offered to those accessing healthcare and of 'service coverage' offered by the system to meet varied health needs. The former is measured by three indicators: overall out of pocket expenditure (OOPE), catastrophic health expenditure and healthcare-related impoverishment due to the cumulative burden of expenditures.

The largest part of OOPE comes from frequent out-patient expenditure on drugs and diagnostics, while catastrophic expenditure is usually related to an acute event that imposes a severe financial strain. Healthcare-related impoverishment can result from one or a combination of the two. Poverty often results when the financial strain is compounded by loss of wages due to illness or disability.

Service coverage is measured through an index developed by the WHO. It combines 14 indicators across health domains. They cover reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases, service capacity and access.