On the path to Universal Health Coverage: aligning ongoing health systems reforms in India

Non-communicable diseases (NCDs) such as heart disease, diabetes and cancer, which accounted for 30% of disease burden in 1990, represented over 55% of the disease burden in 2016, while communicable, maternal and child diseases accounted for nearly one-third of the burden.2 Addressing these rapid shifts requires a fit-for-purpose health system to move towards Universal Health Coverage (UHC). Aligning primary and hospital care will help to limit current overburdening of higher-level facilities, unnecessary hospitalisations, travel time, loss of economic productivity for patients and ultimately, cost inflation across the health system.6 Incentives for patients to initially seek care at the primary care level could include shorter waiting times for referred surgeries or consultations, compared with those who directly access higher-level facilities. [...]it is imperative that these systems are appropriately aligned from the beginning.8 Mid-level providers and their supporting frontline workers are paid performance-based incentives based on the achievement of pre-determined targets. [...]there is an incentive to maximise the number of packages provided, but to reduce the number of services provided within a given package.