Title page 1

Contents 4

Contributors 9

Foreword 13

1. Introduction: Health Policy and Practice for Universal Health Coverage in Selected Asian Countries 15

1.1. Background and Motivation 15

1.1.1. Purpose of the Book 16

1.1.2. Asia as a Policy Laboratory for Universal Health Coverage 17

1.2. Conceptual Framing of Universal Health Coverage 19

1.2.1. A Life-course Perspective on Universal Health Coverage 21

1.3. Why This Book? Value Added to Existing Literature 22

1.4. Thematic Structure and Chapter Contributions 24

References 26

2. Achieving Universal Health Coverage in Maternal Healthcare: Assessing Quality, Financial Barriers, and Disparities in India 29

2.1. Introduction 29

2.2. Methods 31

2.2.1. Data Source and Sample 31

2.2.2. Data Description 32

2.3. Measures of Maternal Healthcare Quality 34

2.3.1. Quality Antenatal Care 34

2.3.2. Quality Delivery Care 35

2.3.3. Quality Postnatal Care 35

2.3.4. Quality Family Planning 35

2.4. Financial Barriers to Maternal Healthcare 35

2.4.1. Statistical Analysis 36

2.5. Results 37

2.5.1. Background Characteristics 37

2.5.2. Quality Antenatal Care 37

2.5.3. Quality Family Planning Service 48

2.5.4. Quality Delivery Care 51

2.5.5. Quality Postnatal Care 53

2.5.6. State-level Disparities in Maternal Healthcare Quality 57

2.5.7. Correlates of Quality Maternal Health 58

2.5.8. Out-of-pocket Expenditures and Sources of Payment for Delivery Expenses 64

2.6. Discussion 68

2.7. Conclusion 72

References 73

Appendix 78

3. Universal Health Coverage at Birth and Early Childhood Health Outcomes: Evidence from Seven Developing Countries 84

3.1. Background 84

3.2. Methods 90

3.2.1. Data 90

3.2.2. UHC Policy Background 95

3.2.3. Empirical Model 98

3.3. Results 100

3.3.1. Impacts of Early-life Exposure to Universal Health Coverage on Child Health 100

3.3.2. Mechanism Analyses 103

3.3.3. Component Analysis of UHC 105

3.3.4. Heterogeneity Analysis 107

3.3.5. Robustness Checks 110

3.3.6. Impacts of UHC Over Time 112

3.3.7. Additional Analyses: Health Financing Indicators 113

3.4. Discussion 114

3.5. Conclusion 116

References 119

Appendix 126

4. Evaluating Maternal Healthcare Service Utilization Efficiency across India: A Meta-frontier Slack-based Data Envelopment Approach 127

4.1. Background 127

4.2. Literature Review 129

4.2.1. Global Evidence on Maternal Health Efficiency 129

4.2.2. Methods of Efficiency Assessment 131

4.2.3. Theoretical Framework Supporting Variable Selection 132

4.3. Methodology 134

4.3.1. Model Specification and Justification 134

4.3.2. Meta-frontier Analysis 135

4.3.3. Bootstrapped Truncated Regression 137

4.4. Data and Variables 139

4.4.1. Inputs and Outputs for Efficiency Assessment 139

4.4.2. Contextual Variables for Explaining Efficiency Variation 144

4.5. Research Findings 145

4.5.1. Efficiency Analysis 145

4.5.2. Bootstrapped Regression Analysis: Correlates of Efficiency 149

4.6. Discussion 150

4.7. Policy Implications 153

4.8. Conclusion 154

4.8.1. Limitations and Future Scope 154

References 156

Appendix 163

5. Predictors of Out-of-Pocket Expenditure on Health in India: A Disease-Specific and Equity-Based Analysis Using the Growth Diagnostic and 3A Frameworks 170

5.1. Introduction 170

5.2. Data and Methods 173

5.3. Conceptual Framework 174

5.4. Statistical Methods 176

5.5. Results 177

5.5.1. Socio-economic and demographic profile of the sampled population 177

5.5.2. Mean Differential in Out-of-Pocket Expenditure 178

5.6. Covariates of rising burden of health expenditure in India 186

5.7. Discussion 193

5.8. Conclusion 196

5.9. Policy Recommendations and Limitations 197

5.10. Limitations 197

References 199

Annex 1. Socio-economic and Demographic Profile of the Sampled Population: Inpatient over Previous 365 Days and Ailments in the Last 15 Days 204

6. Primary Health Care Performances to Achieve Universal Health Coverage across Indian States: Issues and Challenges 209

6.1. Introduction 209

6.1.1/6.1.2. Achieving universal health coverage in India: Role of primary health care 210

6.1.2/6.1.3. Primary healthcare challenges 211

6.2. Methodology 213

6.3. Results 216

6.3.1. Primary Healthcare Domain Performance across Indian States 216

6.3.2. Health Financing and Primary Care Expenditure in India 218

6.4. Discussion 222

6.5. Conclusion 224

References 225

Annex I. Indicators and Data Sources 228

Annex II. Index Values of Indicators - Ranking Individual Groups 229

7. Public Health Policy Interventions in India and Thailand: A Comparative Analysis of Universal Health Coverage and Health Outcomes 230

7.1. Introduction 230

7.2. Country Background and Research Focus 232

7.3. Data and Methodology 233

7.4. Public Universal Health Coverage and Health Policies in India and Thailand 234

7.4.1. The Indian scenario 235

7.4.2. The Thai scenario 238

7.5. Discussion and Lessons Learned 247

7.6. Policy Recommendations 252

References 254

8. Does Institutional Quality Matter: Good Health and Well-Being in South Asia 268

8.1. Introduction 268

8.2. Literature Review 271

8.3. Data and Methodology 274

8.3.1. Data description 274

8.4/8.5. Addressing endogeneity in institutional quality 279

8.5/8.6. Estimation Results and Discussion 280

8.6/8.7. Institutional Channels, Mechanisms, and Policy Recommendations 283

8.7/8.8. Conclusion 285

References 287

Appendix A1. Estimation Results with Current Health Expenditure per Capita (current US$) 290

Appendix B1. Correlation of Institutional Quality Components Among South Asian Economies 291

Appendix C1. List of Variables Included on the Index of Sustainable Development Goal 3 291

Appendix C2. List of Variables, Short Definitions, and Data Sources 292

9. Digital Health Strategy for Universal Health Coverage: A Comparative Case Study on the People's Republic of China, India, and Indonesia 294

9.1. Background 294

9.2. Methods 298

9.2.1. Study design 298

9.2.2. Case selection 298

9.2.3. Data sources 298

9.2.4. Framework for data analysis 299

9.3. Results 301

9.3.1. Country Case Studies 305

9.4. Discussion 322

9.4.1. Cross-country convergences and divergences 322

9.4.2. Policy suggestions 323

9.4.3. Limitations of the study 324

9.5. Conclusion 324

References 326

Table 1.1. Dimensions of Universal Health Coverage and Policy Levers 20

Table 2.1. Quality Antenatal Coverage in India, by Socioeconomic Characteristics 39

Table 2.2. Quality Antenatal Consultation in India, by Socioeconomic Characteristics 41

Table 2.3. Quality Antenatal Care in India, by Socioeconomic Characteristics 46

Table 2.4. Quality Family Planning Coverage in India, by Socioeconomic Characteristics 49

Table 2.5. Quality Delivery Care in India, by Socioeconomic Characteristics 52

Table 2.6. Quality Postnatal Care in India, by Socioeconomic Characteristics 54

Table 2.7. Quality of Maternal and Newborn Care in India, by Major States 58

Table 2.8. Correlates of Quality of Maternal Health in India, 2019-21: Findings from Multinomial Logistic Regression 59

Table 3.1. Descriptive Statistics 94

Table 3.2. Universal Health Coverage, Child Anthropometric Outcomes, and Vaccination 101

Table 3.3. Impacts of Universal Health Coverage and Nutrition Status 101

Table 3.4. Parallel Trend 103

Table 3.5. Mechanism Analysis, Child Level 105

Table 3.6. Component Analyses 106

Table 3.7. Heterogeneous Impacts of Universal Health Coverage at Birth on Child Health by Socioeconomic and System-level Contexts 109

Table 3.8. Robustness Checks 111

Table 3.9. Impacts of Universal Health Coverage Over Time 113

Table 3.10. Additional Analysis: Health Financing Indicators 114

Table 4.1. Eigenvalue Analysis of Input Variables under Sufficient Care 140

Table 4.2. Component Loadings for Sufficient-care Indicators 140

Table 4.3. Descriptive Statistics of Input and Output Variables, Cluster-wise 142

Table 4.4. Contextual Variables Description and Summary Statistics 144

Table 4.5. Summary Statistics of Efficiency Scores Under the Meta-frontier (MVRS) and Group Frontier (GVRS) 146

Table 4.6. Summary Statistics of Technology Gap Ratio 148

Table 4.7. Environmental Factors Affecting Meta-frontier and Group-frontier Efficiency Scores 149

Table 5.1. Integrating the Availability, Affordability, and Assurance Framework within a Growth Diagnostics Approach for Predicting... 175

Table 5.2. Mean Out-of-Pocket Expenditure for Hospitalization (Last 365 days) under Various Socioeconomic Covariates of the Sample Population, 2017-18 180

Table 5.3. Mean Out-of-Pocket Expenditure under Various Outpatient (last 15 days) Health Expenditure Components by Socio-Economic Covariates 2017-18 183

Table 5.4. Predicted Mean Health Expenditure by Socio-economic and Demography Profile of the Hospitalized Persons in Last 365 Days, 2017-18 188

Table 5.5. Predicted Mean Health Expenditure by Socio-economic and Demography Correlates of the Outpatients in Last 15 Days, 2017-18 191

Table 6.1. Composite Primary Healthcare Performance Index by State (Geometric Mean of Domain-Specific Indices) 217

Table 6.2. Current Health Expenditures by Primary, Secondary and Tertiary Care 219

Table 6.3. State/Union Territory-wise State Programme Implementation Plan Approvals and Expenditure for Ayushman Arogya Mandirs... 221

Table 7.1. Comparative Analysis of the Indian Pre-Universal Health Coverage and Universal Health Coverage Schemes 240

Table 7.2. Comparative Analysis of Thailand's Pre-Universal Health Coverage and Universal Health Coverage Schemes 245

Table 7.3. Country-Specific Lessons Learned from the Adoption of Universal Health Coverage Schemes in India and Thailand 251

Table 8.1. Descriptive Statistics 276

Table 8.2. Correlation Matrix 278

Table 8.3. Estimation Results for Sustainable Development Goal 3: Good Health and Well-Being 281

Table 9.1. Network Readiness Index Ranks and Scores in Three Selected Countries, 2024 297

Table 9.2. Digital Health Maturity Scores in Three Selected Countries 297

Table 9.3. Key Indicators in Three Selected Countries 300

Table 9.4. Universal Health Coverage and Digital Health Transformation in Selected Countries: A Comparative Picture 302

Boxes 8

Box 9.1. The People's Republic of China Leveraged Private Sector Capabilities 307

Box 9.2. India Developed Telemedicine Platform through Incrementalism 312

Box 9.3. Indonesia Strengthened Its Healthcare Supply Chain 320

Table A2.1. Background Characteristics of Women included in the Study, India, 2019-21 78

Table A2.2. Average Out-of-pocket Delivery Cost 80

Table A2.3. Source of Payment for Delivery Cost 82

Table A3.1. List of Countries 126

Table A3.2. In Utero Universal Health Coverage and Early Childhood Health 126

Table A3.3. Mechanism Analysis, Country Level 126

Table A4.1. Selected Cluster-wise District-level Efficiency Estimates 163

Table A4.2. Districts Operating under Decreasing Returns to Scale 168

Table A4.3. Zonal/state Wise Summary Statistics of Meta-frontier Efficiency Scores 169