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Healthcare as an Optional Public Service (HOPS)

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April 13, 2022

Why in news?

The lingering COVID-19 crisis is a good time to revive the universal health care (UHC).

What is Universal Health Care (UHC)?

WHO’s goal- 1 billion more people benefitting from universal health coverage by 2023.

SDG target 3.8 focuses on achieving universal health coverage.

  • Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship.
  • It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
  • Currently, at least half of the people in the world do not receive the health services they need.
  • Monitoring progress towards UHC should focus on 2 things.
    • The proportion of a population that can access essential quality health services (SDG 3.8.1)
    • The proportion of the population that spends a large amount of household income on health (SDG 3.8.2).
  • WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage in countries
    1. Reproductive, maternal, newborn and child health
    2. Infectious diseases
    3. Noncommunicable diseases
    4. Service capacity and access


What are the routes available to achieve UHC?

  • Public service- In this approach, health care is provided as a free public service, just like the services of a fire brigade or public library.
  • This socialist project has worked not only in communist countries such as Cuba but also in the capitalist world.
  • Social insurance- It allows private as well as public provision of health care, but the costs are mostly borne by the social insurance fund(s) so that everyone has access to quality health care.
  • The social insurance is one where insurance is compulsory and universal, financed mainly from general taxation, and run by a single non-profit agency in the public interest (Canada).
  • Other models of social insurance include the one that is based on multiple non-profit insurance funds instead of a single payer (Germany).
  • HOPS framework- Healthcare as an optional public service (HOPS) refers to the framework for UHC that would build primarily on health care as a public service.
  • The idea is that everyone would have a legal right to receive free, quality health care in a public institution if they wish.
  • Health care of decent quality is available to everyone as an optional public service.
  • In Kerala and Tamil Nadu, most illnesses can be satisfactorily treated in the public sector, at little cost to the patient.
  • Here, social insurance could play a limited role covering procedures that are not easily available in the public sector such as high-end surgeries.
  • The main difficulty with the HOPS framework is to specify the scope of the proposed health-care guarantee, including quality standards.

Tamil Nadu has proposed the Right to Health Bill that ensures State’s commitment to quality health care for all.

What are the challenges associated with social insurance?

  • Absence of public health centres- In the absence of public health centres, there is a danger of patients rushing to expensive hospitals making the system wasteful and expensive.
  • Costs- Containing costs is a major challenge with social insurance, because patient and health-care provider have a joint interest in expensive care.
  • Even small co-payments often exclude many poor patients from quality health care.
  • Regulating private health-care providers- A crucial distinction needs to be made between for-profit and non-profit providers.
  • For-profit health care is deeply problematic because of the conflict between the profit motive and the well-being of the patient.

What are the pros and cons of UHC?

  • Pros of UHC
    • Lowers overall health care costs
    • Lowers administrative costs
    • Standardizes service
    • Creates a healthier workforce
    • Prevents future social costs
    • Guides people to make healthier choices
  • Cons of UHC
    • Healthy pay for the sickest
    • Less financial incentive to stay healthy
    • Long wait times for elective procedures
    • Doctors incentivized to cut care to lower costs
    • Health care costs may overwhelm government budgets
    • Government may limit services with low probability of success



  1. https://www.thehindu.com/todays-paper/tp-opinion/hops-as-a-route-to-universal-health-care/article65316184.ece
  2. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
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