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 brings you a study assessing the barriers to Universal Health Coverage in India and the strategies to address them. It further includes a study analysing the questions of out-of-pocket spending, catastrophic health expenditure and distress financing, and treatment pathways in four states of India - Odisha, Uttar Pradesh (UP), Maharashtra and Punjab, an analysis on the relevance of the Contributory Health Insurance for low- and middle-income countries and more. 

Is contributory health insurance indeed an addiction to a bad idea? A comment on its relevance for 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. The problem of a high proportion of informal sector workers that they argue impacts contributory approaches is also an issue with taxes because of the very low numbers of people who file returns. Taxes in most developing countries are in fact largely derived from highly regressive indirect taxes which the poor are forced to pay. Additionally, in most developing countries, including large ones like India and Nigeria, the only choice on offer is continued dependence on out-of-pocket expenditures, write Nachiket Mor, Hasna Ashraf.

Pathways to reimagining commercial health insurance in India

In this paper we explore how India's growing commercial health insurance (CHI) segment can be reformed to deliver adequate financial protection and good health outcomes. We lay out key issues in the demand- and supply-sides of the insurance market that need to be addressed for CHI to be more aligned toward universal health coverage (UHC). On the demand side, we identify a consumer who strays far from the rational actor paradigm and therefore one whose needs require a fundamentally different approach than the one that commercial health insurance in India has so far taken, write Hasna Ashraf, Indradeep Ghosh Nishanth Kumar Anjali Nambiar Sowmini Prasad.

Health seeking behaviour in four Indian States

This study aims to provide an understanding of health seeking behaviour in two States with low levels of health system development: Odisha and Uttar Pradesh; and two with higher levels of health system development: Maharashtra and Punjab.

The study sheds light on the questions of out-of-pocket spending, catastrophic health expenditure and distress financing, and treatment pathways in four states of India - Odisha, Uttar Pradesh (UP), Maharashtra and Punjab. The rationale for this is to better understand the differences between health seeking behaviour in more and less developed health systems at the State level in India, and to sharpen hypotheses about the evolution of health seeking behaviour as health systems develop effectively. The study provides valuable insights for health system interventions yet to be introduced, that seek to strengthen elements such as public primary care, write Barbara McPake, Sumit Kane, Ajay Mahal.

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