UDF promises revamp of health financing and insurance in the State

The report of the health commission set up by the United Democratic Front (UDF) in the run-up to the Assembly elections to examine the State’s public health system has proposed a comprehensive overhaul of the existing health financing and insurance policies. It claims that these reforms would directly reduce out-of-pocket health expenditure.

The commission, headed by S.S. Lal and comprising members who held extensive consultations with public health experts across the State, has recommended the establishment of a comprehensive Universal Health Protection Scheme.

This scheme would cover all eligible citizens, both above and below the poverty line, ensuring that the current “missing middle” — families excluded from the Karunya Arogya Suraksha Padhati (KASP) yet unable to afford private health insurance — are not left without health-care protection. This, the report notes, is essential to prevent catastrophic health expenditure from pushing middle-class families into debt and distress.

The proposal calls for the expansion of universal and effective insurance coverage by strengthening and integrating publicly funded insurance schemes. It recommends automatic enrolment of all eligible households, including the “missing middle,” simplified benefit packages, and genuinely cashless treatment.

The report observes that the current health insurance scheme, KASP, despite its wide coverage, is in disarray due to substantial arrears owed by the government to public and private hospitals and pharmaceutical firms towards claim reimbursements and payments for drugs, diagnostics, and equipment.

It stresses the need to stabilise health insurance financing by improving the sustainability of publicly funded schemes. This can be achieved through timely settlement of claims, realistic budgeting aligned with utilisation levels, and preventing the accumulation of arrears that undermine provider participation.

Patients seeking care in public hospitals are entitled to free medicines and diagnostics. The report proposes a dedicated budget allocation for drugs, laboratory diagnostics, surgical consumables, and accessories for government hospitals to ensure that patients are not compelled to purchase these items elsewhere while receiving care.

The report also recommends strategic reforms in resource mobilisation at the facility level by hospital development committees. It proposes specific guidelines to enhance transparency and accountability in resource utilisation, thereby improving health service delivery.

The commission further suggests strengthening financial oversight and expenditure tracking by enabling the Public Financial Management System (PFMS) to monitor health expenditures at facility, district, and State levels. This would help detect delays, leakages, and underutilisation at an early stage, ensuring that funds are used as intended.

Another key recommendation is the implementation of a unified health information system that assigns a Unique Health Identity (UHID) number to all citizens and integrates patient records, laboratories, pharmacies, and diagnostic services across all public facilities to ensure continuity of care across referral levels.

The report emphasises the need to ensure interoperability of digital platforms to enable real-time data sharing across programmes, facilities, and levels of care, thereby supporting monitoring, planning, and outbreak preparedness. It also recommends establishing care coordination systems to ensure continuity of care across different tiers of hospitals, supported by the latest software solutions.

Finally, the commission has undertaken to examine the shortcomings in Medisep, the health insurance scheme for government employees and pensioners. It recommends ensuring a financial contribution from the government towards the scheme to improve accountability and strengthen its functioning.