Edition 21 | May 17, 2023

Dear Friends,

We are delighted to present to you the next edition of the monthly newsletter by the Lancet Citizens' Commission on Reimagining India’s Health System. This edition discusses the relevance of contributory health insurance for low- and middle-income countries. It further includes a comment on the cooperative healthcare model and its scope in India, an analysis of institutionalizing the public health cadre, inducting family physicians, and more. 

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Is contributory health insurance indeed an addiction to a bad idea? A comment on its relevance for low- and middle-income countries

Financing of health systems is an enduring concern world wide. Yazbeck and colleagues in their paper make an important point that when there is a choice between financing in which contributions from citizens take place in the form of generalised taxes versus those in which they are in the form of insurance premiums, the overwhelming evidence suggests that tax-based financing is unambiguously superior even in low- and middle-income countries. Despite the strength of their case against contributory insurance, we suggest that the path forward may be more complex than they envisage for a number of reasons, write Nachiket MorHasna Ashraf.

Work from the Commission

Cooperative healthcare model: A comment on its scope in India

Achieving universal health coverage (UHC) through tax-financing or social health insurance is often challenging for lower-middle-income countries (LLMICs) with large informal sectors and limited tax bases. In such cases, the potential of alternative financing mechanisms needs to be explored to provide citizens with affordable healthcare while awaiting structural changes, write Nachiket Mor, Hasna Ashraf, Anjali Nambiar.

Teleradiology and technology innovations in radiology: status in India and its role in increasing access to primary health care

There is an inequitable distribution of radiology facilities in India. This scoping review aimed at mapping the available technology instruments to improve access to imaging at primary health care; to identify the facilitators and barriers, and the knowledge gaps for widespread adaptation of technology solutions, write Anuradha Chandramohan, Viswajit Krothapalli, Ann Augustin, Madhavi Kandagaddala, Hannah Mary Thomas, Thambu David Sudarsanam, Ammar Jagirdar, Shalini Govil, Arjun Kalyanpur.

Views & Opinions 

स्वास्थ्य व्यवस्था को बदलने वाला कानून, बजट बढ़ाए बिना सही मायने में नहीं मिल पाएगा स्वास्थ्य का सही अधिकार

अपने देश में प्रायः देखा गया है कि एक बार दिया हुआ वचन न तो वापस लिया जा सकता है और न ही इसे और राज्यों में फैलने से रोका जा सकता है। एक के बाद एक राज्यों में पुरानी पेंशन की उठती मांग इसका ताजा उदाहरण हैनचिकेत मोर लिखते हैं।

India, its SDG pledge goal, and the strategy to apply

The country needs to replicate its COVID-19 response plan to succeed in meeting its SDG targets — one that is also pioneering and a nation-wide effort, writes S.V. Subramanian.

Why this Covid wave is just part of the tide

Can we fully resume normal life, in terms of travel, work, education and socialisation? At present, there are no danger signals to deter us from doing so, while following sensible precautions, writes Prof K Srinath Reddy.


In search of a fix to the primary health care chasm in India: can institutionalizing a public health cadre and inducting family physicians be the answer?

With the aim being to increase community confidence in primary health care, along with the need to augment primary healthcare infrastructure, we argue for a need to augment primary healthcare with physicians trained in family medicine. Provisioning medical officers and general practitioners trained in family medicine can salvage community's confidence in primary care, increase primary healthcare utilization, stymie over-specialization of care, channelize and prioritize referrals, and guarantee competence in healthcare quality for rural communities, write Allen Prabhaker Ugargol, Arnab Mukherji, Ritika Tiwari.

Commission Member in Spotlight 

"I think the key challenge is the tension between the prevailing approach of allowing two systems to operate in parallel (i.e., the public and private), with minimal regulation of either, with the need for a population-based health care system which integrates all providers within a common framework of accountability and quality. Related challenges include the growing reliance on an insurance model which pays for services rather than a per capita model which values health outcomes, the lack of trust between private and public sectors, and the need to aggressively address the single largest contributor to out of pocket costs, which is the inappropriate use of diagnostic interventions and medicines," says Vikram Patel, Pershing Square Professor of Global Health, Harvard Medical School; Professor, Harvard TH Chan School of Public Health; Co-founder, Sangath

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"Our research suggests that India is lacking a lateral health systems approach to provide all levels of care from preventive medicine through tertiary and specialized care. To fully cover the residents of India, the fragmentation between vertical programs will need to be addressed. The other key is finding the right balance between centralized national control of healthcare and decentralized state control. Finding a way to customize and localize care state to state, where there are varying health needs, is critical to serving the population in need," says Noah Carton-Rossen, MPH candidate in health policy, Harvard T.H. Chan School of Public Health

Read full interview
Featured Partner

Population Foundation of India (PFI) is a national non-profit organisation, which promotes and advocates for the effective formulation and implementation of gender sensitive population, health and development strategies and policies. PFI is providing research support to the Citizens' Engagement workstream of the Commission.

Help us develop a roadmap to achieve universal health coverage in India by visiting our website: https://www.citizenshealth.in/

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