Universal healthcare is an aspirational goal for India but while the need for it is generally acknowledged a number of problems stand in the way of realising this goal – lack of adequate allocation of funds from the Centre and the States being the most important one for most of the large States.  For a few Indian States money for universal healthcare is not really a constraint while for several it remains a binding one.  For both types of States the attached note seeks to find a path which takes into account the current financial and other realities on the ground and the immediate needs of the population but which leads to the eventual fulfilment of the dream of universal healthcare.  It argues that where we end up as a country is highly path dependent.The absence of good design thinking would set us on an irreversible path towards poor health outcomes coupled with financially unsustainable expenditures but some careful steps taken now, even when all of the money required is not immediately available, has the potential to gradually progress us towards the holy grail of good financial outcomes coupled with modest total healthcare expenditures.
The note holds out Thailand’s Health System as one that India should use as a model and cites extensively from literature that has studied that country’s experience.  It also builds a case for the introduction of a careful licensing policy for hospitals and for the urgent introduction of mandatory primary-level gatekeeping as a mechanism to control costs and simultaneously improve health outcomes.  It also argues that whether the providers are public sector or private sector and whether the purchasers are commercial insurance companies or health departments directly, is less important that the internal consistency of the overall design.