Universal health coverage
Health financing & equity
Health financing is at the heart of any health system—it determines who has access to care, what services are available and how equitably resources are distributed. Equity in health financing ensures that financial hardship does not prevent people from seeking care and that vulnerable populations are not left behind.
Why health financing matters
Around the world, inequities in health outcomes often reflect inequities in financing. In many low- and middle-income countries, high out-of-pocket expenditures continue to push millions into poverty. A well-designed health financing system should:
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- Pool risk equitably across the population
- Ensure predictable and sufficient funding for essential services
- Minimize financial barriers to access, especially for the poor and marginalized
- Promote efficient and accountable use of resources
Ayushman Bharat: Pradhan Mantri Jan Arogya Yojana
As the founding CEO of the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY), I had the privilege of designing and implementing a program that aimed to address the dual challenge of access and affordability. PM-JAY covers over 500 million Indians for secondary and tertiary care hospitalization, fully funded by the government.
Equity was a core design principle of Ayushman Bharat. Key features included:
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- Targeting the most vulnerable 40% of the population based on deprivation and occupational criteria
- No cap on family size or age, ensuring that large and multi-generational households were included
- Gender-sensitive provisions, such as prioritizing women-headed households and covering childbirth-related procedures
- Portability, allowing migrants and seasonal workers to access care across India
- Elimination of point-of-care payments, offering cashless access to care in empanelled public and private hospitals
Regional & global good practices
Beyond India, countries across the Global South have pioneered innovative health financing strategies:
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- Thailand’s Universal Coverage Scheme pools tax-based funding to offer comprehensive benefits to all citizens.
- Rwanda has achieved near-universal health coverage through community-based health insurance (mutuelles).
- Indonesia’s Jaminan Kesehatan Nasional (JKN) is among the world’s largest single-payer systems.
- Ghana’s National Health Insurance Scheme finances services through earmarked VAT and payroll deductions.