xxxii
Preface
outline pragmatic and affordable pathways to achieving universal coverage based on realistic assumptions of fiscal capacity, the current configuration of health financing and delivery arrangements, lessons and innovations from GSHISs, and international experience. Most can be implemented over a five-year period and could be included in India’s forthcoming 12th Five Year Plan for economic development. The proposal consists of developing and implementing: (1) The GOI-financed standard benefits package of secondary and maternity care for the BPL population. The proposal builds upon RSBY design and implementation experience. The package would contain services currently covered under RSBY—mostly secondary and maternity care. It would therefore provide coverage against many (but not all) frequent and financially catastrophic hospitalization events. Similar to RSBY, the benefits would be fully subsidized, portable across India, and directed to the BPL population. (2) The GOI-financed standard ambulatory package for the BPL population, delivered through the existing primary care system. This would also strengthen ties between the GSHISs and the public delivery system for referral for inpatient services and follow-up care after discharge. Three approaches are outlined: (a) package payments for defined periods of postdischarge, follow-up care (e.g., consultation, diagnostics, and drugs) for insured patients, which can be provided in government primary health centers (PHCs), community health centers (CHCs), and other contracted primary care providers; (b) capitation and package payments for defined bundles of primary care services that are tied to performance in government PHCs/CHCs (such as antenatal care package, infant care package, diabetes management package); nongovernmental organizations can also be contracted under this arrangement to deliver primary services in localities with no, or inadequate, governmental services; and (c) standard outpatient insurance “product” bought from insurers for care provided by public and private outpatient clinics and hospitals. (3) State-financed “top-off” benefits for the BPL population. States can be incentivized to offer an expanded set of tertiary care benefits beyond the coverage under the GOI-financed common package, aimed at the BPL group but drawing on states’ own resources according to their fiscal capacity. Similar to the GOI-financed common package, the benefits would be fully subsidized (e.g., cashless) for BPL populations without any premium contributions or cost sharing when using services. The GOI and states may draw on the utilization experience of