UNICEF India, New Delhi, India.
Lancet. 2011 Feb 19;377(9766):668-79. doi: 10.1016/S0140-6736(10)61884-3. Epub 2011 Jan 10.
India's health financing system is a cause of and an exacerbating factor in the challenges of health inequity, inadequate availability and reach, unequal access, and poor-quality and costly health-care services. Low per person spending on health and insufficient public expenditure result in one of the highest proportions of private out-of-pocket expenses in the world. Citizens receive low value for money in the public and the private sectors. Financial protection against medical expenditures is far from universal with only 10% of the population having medical insurance. The Government of India has made a commitment to increase public spending on health from less than 1% to 3% of the gross domestic product during the next few years. Increased public funding combined with flexibility of financial transfers from centre to state can greatly improve the performance of state-operated public systems. Enhanced public spending can be used to introduce universal medical insurance that can help to substantially reduce the burden of private out-of-pocket expenditures on health. Increased public spending can also contribute to quality assurance in the public and private sectors through effective regulation and oversight. In addition to an increase in public expenditures on health, the Government of India will, however, need to introduce specific methods to contain costs, improve the efficiency of spending, increase accountability, and monitor the effect of expenditures on health.
印度的卫生筹资体系是导致卫生不公平、卫生资源供应和可及性不足、获得机会不平等以及医疗服务质量差且费用高的原因之一，也是加剧这些问题的因素。人均卫生支出低，公共支出不足，导致印度的私人自付费用在世界上占比最高。公共部门和私营部门的公民获得的医疗服务价值都很低。在印度，仅有 10%的人口拥有医疗保险，因此，针对医疗支出的财务保障远未普及。印度政府承诺在未来几年内将公共卫生支出占国内生产总值的比例从不到 1%提高到 3%。增加公共资金投入，加上中央向邦灵活转移财政资金，将极大地改善邦运营的公共系统的绩效。增加公共支出可用于引入全民医疗保险，从而有助于大幅减轻医疗私人自付支出的负担。增加公共支出还可以通过有效监管，提高公共部门和私营部门的质量保证。除了增加卫生公共支出外，印度政府还需要引入具体方法来控制成本、提高支出效率、增加问责制，并监测卫生支出的效果。
