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 Table of Contents  
PERSPECTIVE
Year : 2019  |  Volume : 4  |  Issue : 2  |  Page : 53-55

Himachal Pradesh – a hilly state of India on path of – Universal health coverage


1 District Program Officer, O/o Chief Medical Officer, Shimla, Himachal Pradesh, India
2 Assistant Professor, Department of Radiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication10-Jul-2019

Correspondence Address:
Dr. Sumala Kapila
Department of Radiology, IGMC, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_14_19

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  Abstract 


Himachal Pradesh (HP) is one of the states of India with a population of 6,864,602 and density of 123/km2. In the first healthy states, progressive India report on the ranks of states and union territories, HP scores overall 5th rank in health index based on reference year 2015-2016. Similarly, in first of its kind, “Health of nation states” report published recently revealed disease burden status of respective states and HP falls under highest epidemiological transition levels with epidemiological ratio of <0.31 in 2016 which was 1.14 in 1990. Particularly, the leading causes of disability-adjusted life years were reported as ischemic heart disease and chronic obstructive pulmonary disease for HP. These above-stated factual indicators reflect on high expenditure being incurred by an average resident of state suffering from any form of noncommunicable diseases while assessing health-care services. Sustainable development goal 3 and 3.8 of financial risk protection is being addressed through various government-sponsored schemes envisaging National Health Policy-2017 goals. Government of HP had taken major strides for Universal Health Coverage (UHC) and extended the similar benefits of Ayushman Bharat scheme to all sections of society with notification of Himachal Health Care scheme on December 29, 2018. Being a hilly state, HP is having its own challenges of inaccessibility and disparities, but its journey and direction on path of UHC is well directed and aptly supported by government policies.

Keywords: Health policy, Himachal Pradesh, universal health coverage


How to cite this article:
Sharma GA, Kapila S. Himachal Pradesh – a hilly state of India on path of – Universal health coverage. Int J Non-Commun Dis 2019;4:53-5

How to cite this URL:
Sharma GA, Kapila S. Himachal Pradesh – a hilly state of India on path of – Universal health coverage. Int J Non-Commun Dis [serial online] 2019 [cited 2019 Sep 21];4:53-5. Available from: http://www.ijncd.org/text.asp?2019/4/2/53/262466



Himachal Pradesh (HP) is one of the states of India with a population of 6,864,602 and density of 123/km2. Almost 48 years ago, it was crafted as a separate state on Indian map comprising predominantly of hilly regions. Since then, this state had made huge strides in progress on all sectors, particularly in education and health. Overall literacy rate of HP is 83.7% holding 11th rank as per the last Census completed in 2011.[1] In the first healthy states, progressive India report on the ranks of states and union territories, HP scores overall 5th rank in health index based on reference year 2015-2016. Since long, various state governments had taken various steps with commitment on common goals with regard to health care of masses.

The World Health Organization has defined Universal Health Coverage (UHC) as “ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”[2] UHC is mainly three-dimensional concepts with key essence of realizing sustainable development goals (SDGs) by 2030. Three key components are population coverage, services offered/covered, and financial risk protection. To access health care, how much an individual pays out of pocket (OOP) is vital concern globally, and inclusion of financial risk protection addresses that concern.

HP has undergone rapid epidemiological transition with regard to disease burden. In first of its kind, “Health of nation states” report published recently revealed disease burden status of respective states and HP falls under highest epidemiological transition levels with epidemiological ratio of <0.31 in 2016 which was 1.14 in 1990.[3] This epidemiological ratio indicates striking shift of the burden of diseases from communicable, maternal, neonatal, and nutritional diseases to noncommunicable diseases (NCDs). Particularly, the leading causes of disability-adjusted life years were reported as ischemic heart disease and chronic obstructive pulmonary disease for HP. During the same period, average life expectancy of male and female in HP had also increased from 71.0 to 76.9 years, respectively. These above-stated factual indicators reflect on high expenditure being incurred by an average resident of state suffering from any form of NCDs while assessing health-care services. According to National Health Accounts estimate for India released in October 2017, total health expenditure (THE) and OOP expenditure for HP was found to be Indian National Rupee (INR) 4547 and 2274 per capita, respectively, contributing 50% of THE.[4]

The Government of India has rolled out Ayushman Bharat-National Health Protection Scheme (AB-NHPS) recently to cover 500 million most vulnerable and poor residents. All members of entitled families are provided with portable, cashless health insurance cover of 5 lakh INR on annual floater basis. Expenditures covered under the scheme are specifically for day care surgeries or ailments warranting admission at secondary and tertiary care level institutions and usually high expenditure costs incurred during treatment duration. In HP, a total number of households selected for enrollment under AB-NHPS is 2.77 lakh of total 14.27 lakh.[5] Government of HP had taken major step for UHC among those left out and had extended the similar benefits to all sections of society with notification of Himachal Health Care (HIMCARE) scheme on December 29, 2018.[6] It is pertinent to mention here that all regular employees of HP government are already entitled for medical reimbursements for any illness reported as per state policy. HIMCARE scheme is being offered to vulnerable section left out from beneficiaries under AB-NHPS with benefit restricted to maximum five members of the family. Enrollment is offered under three categories. The first category is those who are not enrolled under AB-NHPS but is below poverty line and those who are registered as roadside vendors. The first category beneficiaries need not pay anything for enrollment to avail benefits. The second section comprises mainly of 10 categories, senior citizens (70 years and above), single woman, more than 70% disabled persons, contractual employees, part-time workers, daily wage workers, midday meal workers, and others. The second category aspirants need to pay INR 365/annum for enrollment under the scheme. The last section of beneficiaries under HIMCARE scheme is those who do not fall under category 1 or category 2 and do not fall under any other medical reimbursement option scheme as government employee. Category 3 beneficiaries are also being offered the same health cover amount of Rs. 5 lakh/annum/family but with enrollment fees of 1000 INR per year. Regular government employees are already entitled to medical reimbursement as government policy and, therefore, barred from enrollment under HIMCARE. As comprehensive beneficiaries are eligible for enrollment under HIMCARE scheme from all sections of society state government had taken decisive step toward financial risk protection arising out of catastrophic health expenditures incurred. Simultaneously, health and wellness centers (HWCs) are also being developed across the state to cater comprehensive primary health-care needs of people and government has initiated the process with establishment of 130 such centers in the first phase of implementation in the current year only.

In this hilly state with significant geographical disparities and challenges, establishment of HWC in far-flung areas indicates a paradigm shift in government policy in addressing health-care needs through primary health-care setup, thereby addressing another component of UHC.

Reflecting on various schemes and services being offered, it seems obvious that HP government is focusing on every section of society to reduce OOP expenditure incurred and at the same time enhancing utilization of health-care service by those who were unable to access it earlier due to financial hardships involved. SDG 3 and 3.8 of financial risk protection is being addressed at multiple levels through various government-sponsored schemes envisaging national health policy-2017 goals. To conclude, being a hilly state, HP is having its own challenges of inaccessibility and disparities, but its journey and direction on path of UHC is well directed and aptly supported by government policies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Census of India. Provisional Population Totals, Paper 1 of 2011 India, Series-1. New Delhi: Office of the Registrar General & Census Commissioner; 2011a. Available from: http://www.censusindia.gov.in/2011-prov-results/data_files/india/Final_PPT_2011_chapter 6.pdf. [Last accessed on 2019 Mar 28].  Back to cited text no. 1
    
2.
World Health Organization. The World Health Report: Health Systems Financing: The Path to Universal Coverage. Geneva, Switzerland: World Health Organization; 2010. Available from: http://www.whqlibdoc.who.int/whr/2010/9789241564021_eng.pdf?ua=1. [Last accessed on 2019 Mar 23].  Back to cited text no. 2
    
3.
Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. India: Health of the Nation's States – The India State-Level Disease Burden Initiative. New Delhi, India: Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation; 2017.  Back to cited text no. 3
    
4.
National Health Systems Resource Centre. National Health Accounts Estimates for India (2014-15). New Delhi: Ministry of Health and Family Welfare, Government of India; 2017. Available from: https://www.mohfw.gov.in/sites/default/files/National%20Health%20Accounts%20Estimates%20Report%202014-15.pdf. [Last accessed on 2019 Jan 20].  Back to cited text no. 4
    
5.
Ayushman Bharat Yojna; 2018. Available from: https://www.pmjay.gov.in/state?tid=4. [Last accessed on 2019 Mar 23].  Back to cited text no. 5
    
6.
The Himachal Health Care Scheme; 2019. Available from: https://www.hpsbys.in/content/mmmn. [Last accessed on 2019 Mar 28].  Back to cited text no. 6
    




 

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