To attain the goal of ?health for all? by 2022, a high-powered panel constituted by the prime minister has prescribed a guaranteed access to essential services, including cashless in-patient and free of cost outpatient care for every citizen at public facilties and select private hospitals, under a ?national health package?.

This has been envisaged for all levels of healthcare ? primary, secondary and tertiary. People would be free to supplement these free of cost services offered under NHP by opting to pay out of pocket or private insurance schemes, said health economist, A K Shiva Kumar, also a member of the panel.

Under the model, private players could choose to part-take in the NHP through two ways. Either they may be allowed to participate in the government scheme lest they offer at least 75% of OPD or 50% of inpatient services listed in the package, for which they would be reimbursed at the standardised rates. However, their services would remain under strict regulation. For the remaining services, not part of the package, they may be allowed to accept payments or private insurance polices. Or the second route of private participation may entail commitment from them to provide cashless services exclusively for NHP and mandate them not to offer other services.

On the slew of measures that the Srinath Reddy headed committee presents to finance the scheme include using general taxation as the principal source, along with a surcharge earmarked for healthcare only to be paid by salaried class and taxpayers, either as a proportion of their taxable income or salary. Further, it urges government to increase public expenditure on health to 2.5% of the GDP by the end of 12 th five year plan and 3% by 2022 from the present level of 1.2%.

?General taxation is the most suitable way to go as the organized sector and taxpayer base is widening, the efficiency of tax collection is improving and the goal is to offer cashless healthcare to all,? said Shiva Kumar. FE was the first to report in March that the high powered panel has mooted a healthcare model favouring cashless treatment for all with private participation on a contractual basis.

The panel, which is scheduled to meet the planning commission on Monday with the final proposal, warns strictly against adopting a user fee model, which, they say lead to increased inequalities in healthcare access. The panel also recommends ?specific purpose transfer? of funds to reduce gross disparity in levels of per capita public health spending among states. It cautions against letting insurance companies buy healthcare services on government?s behalf and favours a model wherein all such purchase should be undertaken directly by central or state government or autonomous agencies set up for the very purpose. The panel suggests that 70% of all such expenses should be directed towards primary healthcare.

?Today India stands on a critical transition point from the healthcare policy perspective. The policymakers must ask a few important questions before they embark on this journey of universal health coverage. They must weigh priority that needs to be accorded to health versus financial protection, relative versus universal coverage and customise suitable instruments of financing and delivery of healthcare services, keeping in mind India?s institutional constraints,? said Peter Berman, Harvard School of Public Health, at the Indian Health Economics and Policy Association (IHEPA) conference.

The IHEPA is a think-tank founded by eminent academician ? Indrani Gupta, Ajay Mahal, Rama Baru, AK Shiva Kumar, Seeta Prabhu among others to bridge the gap between academics and policymaking in healthcare.

Abhijit Sen, member, planning commssion, feels that India may finally opt for a hybrid of the model suggested by high level expert group and scaling up of Rashtriya Swasthya Beema Yojana.

?Our study shows that overall, reporting on illness, extent of non-treatment and discontinued treatment has shot up in last two decades. Also, there have been serious hikes

in the cost of healthcare in a similar period,? said Gita Sen of IIM, Bangalore.