Health Policy and Law Reports

Public Health Policy in India: Evolution, Implementation, and Persistent Challenges in the Pursuit of Universal Health Coverage

Aarav S. Mehta — 2026-10-30

India's public health policy framework has undergone substantial transformation since independence, culminating in the National Health Policy (NHP) 2017 and the Ayushman Bharat initiative, both oriented toward universal health coverage (UHC). Despite these reforms, persistent gaps in financing, workforce, and equitable access continue to shape health outcomes. This review synthesizes peer-reviewed literature on the evolution, implementation, and outcomes of public health policy in India, with emphasis on health financing, primary care delivery, and programme performance. A narrative review of journal articles indexed in PubMed, Scopus, and Google Scholar (2005–2025) was conducted using terms related to Indian public health policy, Ayushman Bharat, National Health Mission, and health system financing. Public health expenditure rose marginally from 0.9% to 1.6% of gross domestic product between 2017 and 2022, remaining below the NHP target of 2.5%. Out-of-pocket expenditure continues to account for a large share of total health spending, exposing households to catastrophic expenditure. Ayushman Bharat's two pillars, Health and Wellness Centres and Pradhan Mantri Jan Arogya Yojana, have expanded primary care access and financial protection, though implementation gaps in workforce density and service readiness persist, particularly in rural areas. India's public health policy architecture has made measurable progress toward UHC, but sustained investment in financing, human resources, and primary care infrastructure is required to close the implementation gap.

Health Insurance and Reimbursement Policy: A Comprehensive Review of Global Systems, Mechanisms, and Emerging Challenges

Nur Aisyah Rahman — 2026-10-30

Health insurance and provider reimbursement policies play critical roles in ensuring equitable financial protection, healthcare accessibility, and efficient service delivery. However, fragmented insurance coverage, rising healthcare expenditures, and inconsistent provider payment incentives continue to undermine the sustainability and equity of health financing systems worldwide. This review aims to critically examine major health insurance models and provider reimbursement mechanisms, evaluate their comparative advantages and limitations, and identify policy strategies for strengthening universal health coverage (UHC). Drawing on peer-reviewed literature from high-, middle-, and low-income countries, the review synthesizes evidence on social and national health insurance, private and voluntary insurance, and community-based schemes, alongside fee-for-service, capitation, diagnosis-related group (DRG)-based payment, and value-based reimbursement mechanisms. The synthesis indicates that insurance models differ in their capacity to promote risk pooling, financial protection, and equitable access, while reimbursement mechanisms create distinct incentives affecting healthcare costs, service utilization, and quality. Persistent challenges include catastrophic out-of-pocket expenditures, claims fraud, fragmented risk pools, and unequal access to insured services. Emerging developments, particularly telemedicine reimbursement and UHC financing reforms, introduce additional opportunities and implementation challenges. No single insurance or reimbursement model consistently achieves optimal outcomes across different healthcare settings. Instead, effective health financing requires context-specific policy combinations supported by adequate risk adjustment, transparent claims management, and strategic purchasing. Strengthening revenue collection, integrating fragmented risk pools, and implementing evidence-based, quality-linked reimbursement policies are essential for improving financial protection, healthcare efficiency, and the long-term sustainability of UHC.

Two Decades of Reform, One Decade of Insurance: A Secondary-Data Analysis of Health Financing Policy and Universal Coverage Performance in Indonesia, 2014–2024

Kartika Wibisono — 2026-10-30

Indonesia’s Jaminan Kesehatan Nasional (JKN) has become one of the world’s largest single-payer health insurance schemes, yet concerns remain regarding financial sustainability, financial protection, and equity. This study examined national health financing trends in Indonesia from 2014 to 2024 using secondary data from BPJS Kesehatan, National Health Accounts, the National Social Security Council, the World Health Organization, and nationally representative household studies. JKN membership increased from 133.4 million people (53.0% population coverage) in 2014 to 276.5 million (98.0%) in 2024. However, current health expenditure remained below 3.2% of gross domestic product throughout the period. The out-of-pocket share of current health expenditure declined from 37.8% in 2015 to 27.7% in 2020 but increased to 31.2% in 2022. Catastrophic health spending at the 10% threshold decreased from 7.9% in 2018 to 4.4% in 2019, although poorer and rural households remained disproportionately affected. Public-sector healthcare spending was mildly pro-poor, whereas private-sector benefits remained strongly pro-rich. Indonesia has therefore achieved near-universal JKN enrolment, but population coverage has not fully translated into equitable financial protection. Strengthening strategic purchasing, diversifying financing sources, improving expenditure efficiency, and addressing socioeconomic and geographic inequalities remain priorities for sustainable universal health coverage.

Mental Health Policy in India: Progress, Challenges, and Pathways Forward

Ananya R.L. Deshpande — 2026-10-30

Mental health policy in India has undergone substantial transformation over the past decade, anchored by the Mental Healthcare Act (MHCA) 2017, the National Mental Health Programme, and, more recently, digital initiatives such as Tele-MANAS. This narrative review synthesizes evidence on the legislative, epidemiological, health-systems, and digital dimensions of mental health policy in India. Drawing on 20 peer-reviewed journal articles, the review examines four interrelated domains: (a) the epidemiological burden of mental disorders as documented by the National Mental Health Survey and the Global Burden of Disease study; (b) the evolution and rights-based orientation of mental health legislation, including the decriminalization of suicide; (c) health-system responses, including the District Mental Health Programme, workforce shortages, and the estimated cost of implementing the MHCA; and (d) the expansion of digital and tele-mental health services, accelerated by the COVID-19 pandemic. Four synthesis tables and a conceptual radial diagram map the interconnected pathways linking legislation, epidemiology, service delivery, and digital innovation to population mental health outcomes. Findings indicate that while India's legal framework is now among the most rights-oriented globally, implementation continues to be constrained by an acute shortage of mental health professionals, uneven infrastructure across states, and persistent stigma, even as tele-mental health platforms show promise in narrowing the treatment gap. Implications for policy financing, workforce development, and future research are discussed.

Healthcare Governance and Administration in Indonesia: A Narrative Review of Structures, Financing, Service Delivery, and Reform

Ayu Kartika Sari — 2026-10-30

Indonesia's health system operates across roughly 17,000 inhabited islands and 34 provinces under a governance model that has shifted repeatedly between centralization and decentralization since 1999. This narrative review synthesizes evidence on the governance and administration of healthcare in Indonesia across four domains: the regulatory and institutional framework, health financing and insurance administration, health service delivery administration, and cross-cutting governance challenges including pandemic response and digital transformation. Decentralization devolved substantial authority for health planning, financing, and workforce deployment to district governments, producing gains in local responsiveness alongside persistent disparities in service readiness, medicine availability, and workforce distribution. The National Health Insurance Program (Jaminan Kesehatan Nasional), administered by BPJS Kesehatan, has expanded population coverage but continues to face challenges of financing equity and provider payment sustainability. The 2023 Omnibus Health Law consolidated eleven prior statutes into a single regulatory framework, introducing both opportunities for coherence and concerns regarding recentralization and reduced local participation. Governance of primary care, hospitals, and the health workforce remains uneven, while digital health platforms and pandemic-era coordination mechanisms illustrate both the promise and the fragmentation of multilevel stewardship. Strengthening accountability, financing equity, and institutional coordination across central and local government levels emerges as the central reform agenda for Indonesian healthcare governance.