1. Estimating Universal Health coverage
Dr. N. Devadasan,
Institute of Public Health,
Bangalore, India

2. UHC Universal health coverage ? Universal health care ?
Ensuring that ALL people can use the health services they need of sufficient quality to be effective, while also ensuring that the use of services do not expose the use to financial hardship
3/01/2013
Presentation at NHSRC

3. Coverage
3/01/2013
Presentation at NHSRC

4. Why estimate? UHC is about moving from point A to point B
We need to know where we are currently
Point B is usually 100% coverage
We need to develop the strategy to reach Point B
3/01/2013
Presentation at NHSRC

5. WHR 2010
3/01/2013
Presentation at NHSRC

6. What to estimate Financial Population Services Quantitative
Qualitative
3/01/2013
Presentation at NHSRC

7. Indicators for financial coverage
Source of data
% of population who are insured
IRDA reports
% of population who are covered under a pooled fund
Census
THE as a % of GDP
NHA
OOP as a % of THE
Incidence & Intensity of CHE
NSSO
Incidence & Intensity of Impoverishment
% of patients who make OOP
? NSSO, NFHS, Simple studies
3/01/2013
Presentation at NHSRC

8. Examples …
This graph tells us the proportion of population covered by a Social protection scheme. But it does not tell us what benefits they are covered under or the extent of OOP payments
3/01/2013
Presentation at NHSRC

9. Examples …
This graph gives us an idea of the financial coverage. While Malaysia had 100% cover, we see that people have to make high OOP payments. Again from this graph, it is not clear, which populations are making this OOP payments and for what benefits.
3/01/2013
Presentation at NHSRC

10. Population coverage Indicator Source of data Quintiles / MPCE
National surveys
Population Attributable risk
Concentration index
SC / ST ?
3/01/2013
Presentation at NHSRC

11. Examples
3/01/2013
Presentation at NHSRC

12. Indicators for service coverage
Ideally one needs to define the essential health package
3/01/2013
Presentation at NHSRC

13. Indicators for service coverage …
ILO’s access deficit method
MDG countdown method
SARA method
Composite coverage index
3/01/2013
Presentation at NHSRC

14. Indicators for service coverage - Quantitative
Source of data
% of antenatals with full ANC
NFHS, DLHS, CEC
% of institutional deliveries
% of unmet FP needs
NFHS, DLHS
% of children fully immunised
% of children who received ORT
NFHS
% of children who received ARI Rx
TB Case detection rate
RNTCP reports
% of children who slept under a ITN ?
3/01/2013
Presentation at NHSRC

15. Indicators for service coverage - Quantitative
Source of data
OP contact rate
NSSO 60th round
IP admission rate
% of diabetics on regular treatment ?
% of women screened for CA Cervix
% of households with access to toilets
Census
% of households with access to potable water in their house
3/01/2013
Presentation at NHSRC

16. Indicators for service coverage – Quality of care
Source of data
Drop out rate – ANC
Drop out rate – Immunisation
Drop out rate – TB
Infection rate in hospitals
Drop out rate – IUCD ?
3/01/2013
Presentation at NHSRC

17. Service coverage: Examples …
3/01/2013
Presentation at NHSRC
Annual health survey X state

18. Service coverage: Examples..
3/01/2013
Presentation at NHSRC
DLHS, NSSO 60th Round, RNTCP India

19. What to do All indicators? A single composite indicator? A mixture?
3/01/2013
Presentation at NHSRC

20. Services + Population
3/01/2013
Presentation at NHSRC

21. Services + OOP
3/01/2013
Presentation at NHSRC

22. Financial coverage
3/01/2013
Presentation at NHSRC

23. Financial coverage CURRENT STATUS Service coverage Population coverage
3/01/2013
Presentation at NHSRC

24. Limitations Agreement on package Agreement on indicators
Availability of disaggregated data
Validation of this tool
3/01/2013
Presentation at NHSRC

25. Disclaimer Please note that this is a work in progress
Suggestions and criticisms are welcome
3/01/2013
Presentation at NHSRC

26. Dr. N. Devadasan, MBBS, MPH, PhD Institute of Public Health, Bangalore
Thank you
Dr. N. Devadasan, MBBS, MPH, PhD
Institute of Public Health,
Bangalore

27. ILO’s access deficit method
Take stock of all existing financing mechanisms
Affordability of the health services
Availability
Quality of HR and infrastructure
Estimate access deficit
Developing a coverage plan to fill the gaps
3/01/2013
Presentation at NHSRC

28. ILO‘s access deficit … Pop % that can access
% of the group whose services are funded by
Govt HS
Pvt HS
General revenue
Social security
Comm based Fin
Employer based initiatives
PHI
OOP
Subcontracting
Public employees
Private employees
Self employed
Self employed agri
Unemployed
3/01/2013
Presentation at NHSRC