Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 1125  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (262 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References

 Article Access Statistics
    Viewed1168    
    Printed43    
    Emailed0    
    PDF Downloaded7    
    Comments [Add]    

Recommend this journal


 


 
  Table of Contents     
EDITORIAL COMMENTARY
Year : 2018  |  Volume : 64  |  Issue : 3  |  Page : 134-135

Taking the road less traveled: Economic analyses for advancing universal health coverage


National Professional Officer - Universal Health Coverage, World Health Organization, India

Date of Web Publication11-Jul-2018

Correspondence Address:
Dr. C Lahariya
National Professional Officer - Universal Health Coverage, World Health Organization
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_392_17

Rights and Permissions




How to cite this article:
Lahariya C. Taking the road less traveled: Economic analyses for advancing universal health coverage. J Postgrad Med 2018;64:134-5

How to cite this URL:
Lahariya C. Taking the road less traveled: Economic analyses for advancing universal health coverage. J Postgrad Med [serial online] 2018 [cited 2018 Sep 24];64:134-5. Available from: http://www.jpgmonline.com/text.asp?2018/64/3/134/236375




The health services in India are insufficient to meet the needs of the people, even when provision from both public and private sectors is put together.[1] In India, private sector is a major provider with share of 72% and 79% of outpatient and 58% and 68% of inpatient services in rural and urban areas, respectively.[2] The use of private sector health services also means high out-of-pocket expenditure (OOPE) by people, which amounts to two-thirds of total health expenditures in India. The OOPE in the country is one of the highest globally. In India, annually, an estimated 63 million people fall into poverty due to expenditures while accessing health services.[3],[4]

The research evidence and economic analysis on the cost of health services can guide policy interventions for advancing universal health coverage (UHC). However, there are limited research and publications on cost of care and other types of economic analyses in health care in India. Much of the existing evidence is either through specially targeted surveys or model-based estimates, done on ad hoc basis, to fulfill immediate information needs. The available expertise in India to conduct such analyses is also considered rather limited.

This issue of the journal has published a research article by Jadhav and Mukherjee [5] on the health status of patients with hemophilia A, the use of health-care resources by them, and the cost of care. The authors of this paper have observed that the prohibitive cost of care is a factor in the suboptimal management of hemophilia, which leads to serious and debilitating life-threatening outcomes.[5] These observations could be applicable for many other health conditions which require repeated visits to health services and providers. The cost of care is likely to be higher when care is sought in the private sector.

However, this research article does have a few limitations, namely: small sample size, lack of in-depth analysis, insufficient description of policy implications, and does not provide appropriate and relevant solutions. Limitations notwithstanding, this article is important as it has dealt with a topic not sufficiently researched and documented in India – the cost of accessing health services.

Academic research in India continues to largely focus on traditional topics such as family planning and maternal and child health. The possible reasons for not exploring new topics, such as economic analysis in health research are a combination of factors: lack of technical expertise, limited institutional capacity, insufficient funding, and not enough platforms (journals/conferences) to publish/disseminate findings, among others.

The research on emerging topics/themes would be increasingly demanded and required as India aims to progress toward UHC. In addition to cost of care studies, there are other methods of economic analysis [Box 1], which can help understand, inter alia, the cost-effectiveness of services and to assist prioritization and optimal and efficient utilization of limited resources (i.e., technical and allocative efficiencies). This set of evidence would be needed for tracking progress on health status of the population and for selecting appropriate interventions.

In absence of sufficient research evidence, the policy-decisions in India are either delayed or have to rely upon a combination of expert opinion, experience and model-based approaches.

There is an increasing recognition in India to conduct research and analysis at the intersections of evidence generation and policy-making. The National Health Policy (NHP) of India proposes to measure and track disability-adjusted life years.[4] The Indian Council of Medical Research (ICMR) has collaborated with a few agencies for state-specific burden of diseases in India, the findings of which were first published in late 2017. The Union Ministry of Health and Family Welfare, Government of India, has joined a health system knowledge platform.[6] For making the health technology assessment (HTA) process institutional, health technology assessment India (HTAIn) has been set up (initially named as medical technology assessment board (MTAB) at Department of Health Research, Government of India.[7] However, there is a long way before these mechanisms would be able to deliver effectively. Till then and afterward as well, the academic community has an important and complementary role to conduct and publish such researches.

While need for economic analyses in health services is widely acknowledged, catalyzing the research would need a few specific actions.

  • Identify key policy questions in need of evidence: The academic researchers have to be incentivized to conduct and prioritize research in these identified areas.
  • Prioritize resources for capacity building (of researchers at various levels): The institutional mechanisms have to be used to build capacity of researchers in methods and tools for conducting high-quality research and analyses. The government and other stakeholders (including donor agencies) should consider enhancing financial supports and grants for work in area of economic analyses in health services. This is needed for both primary evidence generation as well as use of available data for conducting analysis
  • Develop strategies and approach to communicate research findings in easy to understand manner: beyond their own community, to be understood and used by policy-makers. The bioscience journals can facilitate the process by including a summary of key findings and policy recommendations for laypersons in the final versions of published papers, specially those with policy implications.
  • Establish institutional mechanisms for closer engagement between researchers, policy-makers, or program managers: Annual “research to implementation forum” with participation of academic researchers, policy-makers, program managers, donor agencies, and other interested stakeholders has been proposed in the past.[8],[9] The existing institutions such as NITI Aayog can take lead in this aspect by facilitating the functioning of 'national knowledge platform' and working as 'knowledge and learning hub'.


The opportunity provided by recently announced Ayushman Bharat Program has potential to accelerate these efforts.[3] However, this would require right stewardship backed by funding and technical support from institutions such as ICMR and other stakeholders including international agencies.

The attention on health-economics is relatively recent in India. The lack of scientific evidence could be partially attributed for low government expenditure on health at 1.15% of gross domestic product (GDP). The lack of sufficient data on cost of care and/or impact of illness makes it difficult to estimate additional investment needed by government to deliver those services. Documented evidence on health services on impoverishing effect could guide government to select health services for priority interventions to identify the people falling into poverty.

To conclude, the availability of evidence for informed policy making is one of the limiting factors in optimal allocation and utilization of public resources in India. Although academic researchers have started conducting economic analyses, the pace of transition is slow. There is an urgent need for concerted actions from policy-makers, academic community, and other stakeholders.

Disclaimer:

The author is a staff member of the World Health Organization. The views expressed are personal and should not be attributed to institutions/organizations he has been affiliated in the past or present.



 
 :: References Top

1.
Planning Commission. 12th Five Year Plan of India (2012-2017): Social Sector: Health. New Delhi: Planning Commission; 2012.  Back to cited text no. 1
    
2.
National Sample Survey Organization. Key Indicators of Social Consumption in India: Health. NSS 71st Round, January, June 2014. National Sample Survey Office, Ministry of Statistics, Planning and Implementation. New Delhi: Govt of India; June, 2015.  Back to cited text no. 2
    
3.
Lahariya C. Ayushman Bharat Program and Universal health coverage in India. Indian Pediatr 2018;55;495-506.  Back to cited text no. 3
    
4.
Government of India. National Health Policy-2017. Nirman Bhawan, New Delhi: Ministry of Health and Family Welfare; 2017.  Back to cited text no. 4
    
5.
Jadhav U, Mukherjee K. Assessment of healthcare measures, healthcare resource use, and cost of care among severe hemophilia A patients in Mumbai region of India. J Postgrad Med 2018;64:138-44.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Sheikh K, Kumar S, Ved R, Kumar S, Raman VR, Ghaffar A, et al. India's new health systems knowledge platform-making research matter. Lancet 2016;388:2724-5.  Back to cited text no. 6
    
7.
Press Information Bureau. Medical Technology Assessment Board. Ministry of Health and Family Welfare, Government of India. Available from: http://www.pib.nic.in/newsite/mbErel.aspx?relid=157976. [Last accessed on 2017 Apr 30, 21:30 IST].  Back to cited text no. 7
    
8.
Lahariya C, Menabde N. Evidence to implementation continuum for universal health coverage. Lancet Infect Dis 2015;15:250-1.  Back to cited text no. 8
    
9.
Lahariya C. Strengthening health systems for evidence informed policy making. Indian Pediatr 2015; 52: 931-2.  Back to cited text no. 9
    




 

Top
Print this article  Email this article
 
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow