This document provides an overview of healthcare financing in India. It begins with definitions of health care financing and outlines the key functions of accumulating, mobilizing, and allocating money for health needs. It then discusses the main mechanisms of healthcare financing globally and in India, including how money is raised through taxes, insurance contributions, and other means. It also addresses how funds are pooled and how health services are paid for. The document reviews India's current healthcare financing indicators and challenges, such as low public spending and high out-of-pocket costs. It concludes with initiatives by the Government of India and recommendations to improve healthcare financing in India.
PUBLIC PRIVATE PARTNERSHIP IN HEALTH SECTORfarhad240669
This document discusses public-private partnerships (PPPs) in the health sector in Bangladesh. It defines PPPs as contractual agreements between public agencies and private sectors to deliver public services by sharing risks and rewards. The document outlines the goals, objectives, concepts, and principles of PPPs. It discusses global PPP contexts and scenarios in Bangladesh. It examines PPP approaches, targeted outcomes and benefits, challenges, risks, and opportunities of PPPs in the health sector. The key points are accelerating investments, improved quality, timely delivery, reduced costs, and innovative solutions through PPPs in health infrastructure and services.
The document discusses health financing in India. It provides information on what constitutes a health system and the functions of health financing mechanisms. The main sources of health financing in India are public funds (20.3% of total funds), private funds like household expenditures (72% of funds), and external support (2.3% of funds). Health expenditure in India is 4.8% of GDP, lower than many other countries. Out-of-pocket expenditures constitute a large portion of private health spending. The majority of public health funds are spent on salaries, while hospitalization and medication costs burden households.
Health insurance in India- Dr Suraj ChawlaSuraj Chawla
The document discusses health insurance in India. It defines health insurance and outlines some key milestones in its development. It describes various social health insurance schemes run by the central and state governments like CGHS, ESI and RSBY. It also discusses private health insurance schemes like Mediclaim and the roles of IRDA and TPAs. Overall, it provides a comprehensive overview of the health insurance landscape in India.
The document provides an overview of health economics. It defines economics and health economics, explaining that health economics applies economic principles to issues related to health and healthcare. It discusses key concepts in health economics including resources, markets, and the roles of micro- and macroeconomics. The importance of health economics is that it can inform policies around resource allocation and program evaluation. Methods discussed include cost analysis, cost-benefit analysis, and others.
The document summarizes healthcare financing in India. It discusses that healthcare financing aims to ensure access to health services. The key principles are generating revenue, pooling funds for cross-subsidization between rich/poor and healthy/sick, and purchasing efficient services. In India, healthcare is financed primarily through out-of-pocket payments by households, while government expenditure is low compared to other countries. Reforms like NRHM and RSBY aim to increase public allocation to healthcare. Challenges include expanding coverage with limited resources and improving spending efficiency.
This document provides an overview of health financing, including:
1. It defines health financing and outlines its key principles of raising revenues, pooling risks, and purchasing health services efficiently.
2. It describes different models of health care financing including social health insurance, out-of-pocket payments, and community-based insurance.
3. It discusses the global scenario of health spending, challenges in low and middle income countries, and the need to reduce out-of-pocket costs and improve access to healthcare.
The document provides an overview of India's national health policy and healthcare system. It discusses the history of health planning in India from the pre-independence period to the present, outlining various committees and policies that have shaped the system. The healthcare system in India has a public sector comprising primary health centers, hospitals at various levels, and health insurance schemes, as well as a large private sector. The national health policy aims to improve health services and outcomes through setting priorities and strategic directions.
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare.
This document provides an overview of health insurance. It defines key terms related to insurance such as the insured, insurer, and premium. It describes the purpose of health insurance as providing protection against costs of unforeseen sickness. Various principles of insurance are outlined, including utmost good faith, insurable interest, indemnity, subrogation, and loss minimization. The history and development of health insurance is summarized, including early programs in Germany, the UK, and India. Major public health insurance schemes currently operating in India are described briefly, including ESI, CGHS, and RSBY. Characteristics, terminology, types, advantages, and limitations of health insurance are also summarized.
The document provides an overview of India's healthcare system, including its various components and the roles of the public and private sectors. Some key points:
- The healthcare system comprises sectors like hospitals, insurance, pharmaceuticals, medical tourism, diagnostics, and equipment/supplies.
- The private sector accounts for around 80% of healthcare delivery and has grown significantly due to various factors like reduced government funding and policies encouraging privatization.
- Medical tourism in India is a growing market valued at $3 billion in 2012 due to lower costs compared to other countries.
- The diagnostics sector is highly fragmented but growing at 20% annually with increased healthcare spending and insurance penetration.
- Foreign direct investment
The document summarizes India's National Health Policy 2017. It defines key terms, outlines the history and need for a new policy, and sets quantitative goals. The policy thrusts include ensuring adequate investment in health, organizing public healthcare delivery, and preventive and promotive health. It discusses national health programs and other areas like human resources, financing, and regulation. While the objectives aim to improve health outcomes, some experts question if they are achievable given India's large population and low health expenditure compared to other countries. Fully implementing the policy could help make progress on health goals but also faces challenges.
The document summarizes India's National Health Policy adopted in 1983 and revised in 2002. The 1983 policy aimed to achieve health for all by 2000 through primary health care services and intersectoral coordination. It addressed issues like medical education, rural/urban imbalance, research, and monitoring progress. The 2002 policy updated targets and financing to further develop infrastructure, workforce, programs, and public-private partnerships to improve healthcare access and outcomes across India.
students wonder exactly what health economics is. is it about money in health, more health for the same money ? about health in hospitals or health of the country.
The National Health Policy of 2017 aims to improve health outcomes through coordinated policy action across sectors. It sets goals such as increasing life expectancy and reducing mortality rates. The policy emphasizes preventive healthcare, affordable universal access, and strengthening primary care. It proposes increasing health expenditure and improving infrastructure. The policy outlines strategies for improving national health programs addressing issues like RMNCH+A, immunization, communicable and non-communicable diseases. It focuses on reforms for healthcare financing, governance, and increasing investments in human resources and digital tools.
This document discusses demand and supply in healthcare. It begins by defining health economics as the application of economic principles to healthcare decision making. It then explains the law of demand, stating that demand increases when price decreases and decreases when price increases. Similarly, it describes the law of supply, which says that supply increases when price rises and decreases when price falls. The document outlines Michael Grossman's model of demand for healthcare, which views health as a consumption and investment commodity. It also discusses how supply of healthcare is determined and different types of economic evaluation used to analyze healthcare costs and outcomes.
This document discusses demand for health care and factors that influence demand. It covers the distinction between need and want, Grossman's model of demand for health, and factors like income, prices of substitutes and complements, insurance, and elasticity. The key points are that demand is derived from demand for health, it is influenced by many individual and environmental factors, and having insurance decreases price sensitivity by consumers.
The document defines health economics as the application of economic principles to the health care system. It discusses key concepts in health economics including supply and demand of health care, costs associated with health care like fixed vs variable costs, and methods of economic evaluation used in health care planning like cost-benefit analysis. The document also outlines factors that influence health expenditures like changing demographics and disease patterns, new technologies, and rising public expectations. Overall, the document provides a broad overview of the basic concepts and scope of health economics as a field of study.
This document provides an overview of health economics. It begins by defining health economics as the study of how scarce resources are allocated for healthcare and the promotion of health. It discusses concepts in health economics like resources, scarcity, buyers, and sellers. It also covers microeconomics which looks at individual interactions, and macroeconomics which takes a broader view. The document then addresses topics like health financing through public and private support, economic indicators like GNP and GDP, and issues around health costs and access in India.
The document summarizes the state of public health in India before the National Rural Health Mission (NRHM). There were large health gaps and crises in rural areas, including malnutrition, maternal and infant deaths, and inadequate water supply. NRHM was launched in 2005 to improve rural health systems by making them more accessible, affordable, accountable, and equitable. It focused on increasing access to primary healthcare and reducing child and maternal mortality rates.
The document summarizes several major health insurance schemes in India, including Rashtriya Swasthya Bima Yojana (RSBY), Employment State Insurance Scheme (ESIS), and Central Government Health Scheme (CGHS).
RSBY provides health insurance coverage to Below Poverty Line families, covering hospitalization costs up to Rs. 30,000 and transportation costs up to Rs. 1,000 per visit. Key features include portability of coverage across India and cashless/paperless transactions. ESIS covers employees in organized sectors, providing medical benefits from day one of employment as well as cash benefits for sickness, maternity, disability, and death. It is financed through contributions from employers and employees.
Health financing strategies uhc 27 09 12Vikash Keshri
This document discusses health financing strategies for universal health coverage. It begins by defining universal health coverage and providing historical perspectives. It then discusses the current state of health financing in India, including low public spending, high private out-of-pocket expenditures, and variations between states. The document outlines that achieving universal health coverage requires raising sufficient funds, removing financial barriers, and using resources efficiently. It examines strategies for generating more health resources, utilizing resources effectively to prevent waste, and proposes the key recommendations of India's High Level Expert Group on universalizing access to affordable healthcare.
This document summarizes a presentation on health financing strategies for achieving universal health coverage given by Sourav Goswami and moderated by Dr. Subodh Gupta at MGIMS, Sevagram on June 8th, 2017. The presentation discusses key aspects of health financing policy including universal health coverage goals of access, quality, and financial protection. It covers topics such as revenue raising, risk pooling, purchasing of health services, benefit package design, and principles of rationing health resources. Examples from countries like Moldova and Chile are provided. The current scenario of health financing in India is also summarized, highlighting high levels of out-of-pocket spending and a need to increase public financing to achieve equitable access to
The document discusses health insurance and community health insurance (CHI) schemes in India. It outlines the Rashtriya Swasthya Bima Yojana (RSBY) scheme launched by the Indian government in 2007 to provide health insurance to below poverty line (BPL) families. The key objectives of RSBY are to facilitate health insurance projects in all districts to provide BPL workers and their families up to Rs. 30,000 of annual health coverage. It also discusses issues around regulating private health insurance and ensuring financial sustainability and coverage of key diseases.
Understanding Health Accounts: A Primer for PolicymakersHFG Project
An update of the 2003 brief, this new primer provides an introduction to Health Accounts, the framework (System of Health Accounts 2011 or SHA 2011), and key steps involved in conducting Health Accounts exercises using SHA 2011 with particular emphasis on how policymakers can get involved to facilitate the process. The primer also includes country experiences illustrating show how Health Accounts data can be used for policy purposes, with specific attention to the importance of institutionalizing Health Accounts so that it may serve as an ongoing resource to policymakers.
Universal Health Coverage and Health Insurance - IndiaDr Chetan C P
Presentation is a case about cutting the risk fragmentation and having a universal pool for Health Insurance as one of the tools for achieving UHC in India.
Health care financing in Saudi Arabia is provided mainly through government revenues, accounting for approximately 80% of total health care spending. Government spending on health as a percentage of the national budget has risen from 2.8% in 1970 to 6.4% in 2004. The remaining sources of health care financing include private sources such as personal out-of-pocket payments and employer-sponsored health insurance programs.
Delivering micro health insurance through national rural health missionCIRM
The document proposes a framework for developing sustainable health insurance models under India's National Rural Health Mission (NRHM) to address challenges in health financing. It discusses how health insurance can help risk pooling for inpatient care, increase health service utilization, standardize quality care, and cover access barriers. The document recommends increasing government health spending, addressing supply and demand barriers for the poor, and mitigating risks of catastrophic out-of-pocket expenditures. It analyzes models of community-based health insurance and proposes a national apex body to develop standardized protocols, rates, and referral systems to make health insurance more efficient and equitable.
Data Analysis ....Stepping Towards Achieving Universal Health Coverage(UHC) b...Nazmulislambappy
The document discusses a study on Shasthya Surokhsha Karmasuchi (SSK), a special health care project in Bangladesh aimed at ensuring quality health services without financial hardship. The study aims to assess if SSK can meet universal health coverage requirements and reduce out-of-pocket health expenditures. Interviews were conducted with SSK patients and health providers. Findings indicate SSK successfully eliminates costs for admitted patients but many still face health costs. SSK coverage and services need expansion to better achieve financial protection goals. Challenges include limited treatments covered, scarce resources, and poor infrastructure.
This document provides an overview of public-private partnership (PPP) models for social healthcare insurance in India. It discusses the challenges of healthcare accessibility and affordability for low-income citizens. It reviews the Yeshaswini health insurance scheme in Karnataka as a successful PPP model and notes other states are implementing similar schemes. The document aims to compare different social health insurance models and identify a best-fit model for India.
The health of a people to a very large extent determines their productivity and wealth. The 2010
Population and Housing Census indicates that a significant proportion of the Bunkpurugu-Yunyoo District in
Ghana (over 75%) are living below the poverty line of GH¢228.00 per annum (approximately US $120 per
annum). It then implies that approximately the same proportion or even a little above that might not be able to
access health care under the ‘cash and carry’ system. Inability to access health care will lead to poor health
status of the residents and thus lower their productivity.
The document discusses health care financing. It begins by outlining the objectives of describing national health accounts, the three functions of health care financing, and sources of financing. It then explains national health accounts and their use in tracking health expenditure trends. The three main functions of health care financing are described as resource mobilization, risk pooling, and resource allocation. Various sources of resource mobilization are outlined like general tax revenue, insurance schemes, and out-of-pocket payments. Criteria for assessing financial mechanisms and strategies for health sector reform like user fee systems and improving resource allocation are also summarized.
The document analyzes the total annual cost of 777,020 rupees (US$24,250) for health services provided at a primary health center in India, breaking down costs by type of care such as curative care, communicable disease control, and family welfare. It estimates the per person costs of various services like 24 rupees for an outpatient visit, 131 rupees for full child immunization, and 127 rupees for antenatal, natal and postnatal care for each pregnant woman. The study concludes the cost estimates are comparable to other developing countries and can help determine user fees or insurance premiums.
Australia vs India: Health care insuranceVedica Sethi
Health care insurance: A Comparative overview.
The retrospective review focuses on the timeline of Healthcare systems and development of Healthcare Insurance policies of India and Australia. The review also includes
the consensus and impact of Healthcare legislature in India and Australia and offers a
comparison to the development in the BRICS countries.
The document discusses various options for financing health care, including user charges, public subsidies, community financing, health insurance, and private sector involvement. It notes that while each method has strengths, none are fully adequate alone and that a mix of approaches is typically needed to meet a population's total health care needs.
2. Plan of presentation
Introduction
Healthcare finance mechanism
Pattern of healthcare finance across world
Healthcare finance in India
Initiatives GOI
Other model of financing
Challenges &
Recommendation
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3. Health Care Finance
Definition : “Function of a health system
concerned with the accumulation, mobilization
and allocation of money to cover the health needs
of the people, individually and collectively, in the
health system.” (WHO)
Purpose :
Make funding available
Set the right financial incentives for providers
To ensure that all individuals have access to effective
public health and personal health care.
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4. Cont…
Health financing linked to the provision of services
and the system’s capability to achieve its stated
goals.
Health financing is raising of resources to support
to pay for goods and health services.
NEED?
Scarcity of Resources – Need for judicious use
Sustainability of resources
Resource efficiency
5. Health is a human right.
India is at an exciting and challenging period in its history.
key focus area : Making healthcare affordable and
accessible for all
The challenges:
Nearly 73% of the country’s population lives in rural areas
and 26.1% is below poverty line.
India lacks strong healthcare infrastructure,
Several inherent weaknesses in its healthcare system
Dominant private sector in India, with 70% catered by it.
Epidemiological transition
Demographic transition
Economic slow down
Etc.
6. According to definition health financing is
Accumulation/collection
Mobilization
Allocation of money
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7. Health Financing Mechanism
Health care financing is about 3 questions:
1.How is the money raised?
2.How are funds pooled? And
3.How are services paid for?
ANSWERS ARE :
1.Revenue Collection
2.Risk pooling
3.Purchasing of health services
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8. 1. How is the money raised ???
Revenue collection :
4 main ways of raising money for health
care:
1. Taxation-most equitable system of financing
2. Health insurance contributions
Social health insurance
Private health insurance
Community based health insurance
1. User pays (out of pocket, no reimbursement)
2. Donor funding/Grants
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9. 2. How are funds pooled ???
Mobilization :
Accumulation & management of Revenue
with respect to
Health Risk
Subsidy
Cross Subsidy
Pooling to redistribute health risk
Cross subsidy for greater equity
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11. 3. How are services paid for ???
Purchasing of health services :
It is done by public or private agencies that spend
money either to provide services directly or to
purchase services for their beneficiaries.
Purchaser :
–
–
–
–
–
Ministry of health (MOH)
Social security agencies
District health board
Insurance organization
Individual or household
Purchasing
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Passive
strategic
11
12. Purchasing model
It is based on the organizational relationships and
contractual or purchasing relationships :
First model : where the government owns the buildings and
employs the staff directly.
Second model: the patient provider contract, The patient
pays the provider and then seeks re-imbursement from their
insurer.
Third model: the purchaser provider contract, The provider
have to provide services to the patient but the payment is
paid by funder (Govt & insurer).
Fourth model: the patient pays the provider out-of-pocket
and because the cost is not covered by insurer & it is not reimbursable.
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14. Allocation of money
Through budgeting in public sector:
BUDGET : Estimating the requirement of money
to perform the activities during any particular
period.
Line item budgets : budget allocation for functional
category,
Global budgets : allocation to health facilities & typically
depend on the type of health facility, historical facility
budget, no. of beds or utilization rates for past years.
Capitation : is a payment method that allocates
predetermined amount of funds per year for each person
enrolled with given provider or resident in a catchment area.
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15. Patterns of healthcare financing
across the world.
Broadly, there are three patterns:
The National Health Service (NHS) of the U.K. is a stark
example of a state-run and publicly-funded system.
the U.K. uses tax finances to pay for 80 per cent of its
healthcare spending.
In Europe, social insurance schemes bear most of the
financial burden.
The U.S. relies on private insurance, paid for mostly by
employers: almost half of the supersized health spending
(16 per cent of GDP) is financed by tax money for the care
of the old and the very poor.
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18. Budget allocation in India
Allocation of money through five year plan
Annual allocation within the available five year
funds.
State
Ministry of Finance
(State have their own fund also)
Ministry of health & FW
Dept of health
MOH
M of FW M of AYUSH
Govt Health provider
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Other sector
(Eg. Edu, social
Welfare)
Private provider
18
19. Health Department in consultation with the Directorate
prepares the list of continuing schemes and new schemes.
Discussed with Planning Commission meetings before
finalization.
Plan for setting up new CHCs, PHCs, determined not on
the need basis but centrally on the resource availability
basis.
Final allotment of plan budget is approved
Transfer of budget to state from the ministry declined
sharply from nearly 57% to 44%.
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20. Budget Process
Plan vs Non-Plan budget.
Need based vs Resource based budget
Capital vs Revenue budget
Top-down vs bottom up approach
21. Performance Budget
In which the purpose and objectives for which
funds sought are very clear
To bring out the programmes and
accomplishments in financial and physical terms.
Better understanding and better review of the
budget by the legislature.
To facilitate the process of decision making at all
levels of government.
To enhance the accountability of the management
To render performance audit more purposeful and
effective.
22. Cont..
I.
Details of the structure of the organisation, the
purpose and objectives, achievement, and work
needed to be done more specifically during the
budget year.
II. The financial requirement under programme wise
classification and items wise expenditure.
III. Explanation for the financial requirements given in
part II.
23. Zero base Budgeting
It focuses on a thorough review of expenditure to
evaluate its continued utility to serve a specific
purpose or a clearly stated objective.
In conventional budget ‘base’ to which increment
is added is treated as authorised and is not
reviewed.
In ZBB the activities of an organisation should be
viewed afresh and the priorities decided.
24. Indicators for assessment of
healthcare financing
1. Total expenditure on health as % of GDP
2. Per capita total health exp. at average exchange
rate
3. Govt exp. on health as % of total Govt exp.
4. Public spending on health as % of total health
exp.
5. Out of pocket spending as % of private
expenditure on health
6. Donor spending on health as % of total health
spending
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25. Cont…
7. % of govt health budget spent on
outpatient/inpatient care
8. % of govt health budget spent on1. Salaries of worker
2. Medicine and supplies
3. Other recurrent cost
8. Health Insurance:
1. % of population covered by various insurance scheme
2. Social security exp on health as % of general govt exp
on health
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26. Total expenditure on health as %
of GDP
It is a share of a country’s total income that is
allocated to health by all public, private & donor
services
It should be between 2-15% of GDP
The provisional estimates from 2005–06 to 2008–
09 shows that it has come down to 4.13% in 2008–
09 from 4.25% in 2004. (source- NHA 2004-05)
India’s total expenditure is comparable with other
Asian countries .
Global average - 8.3%.
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30. Per capita total health exp.
The per capita health expenditure for India in
2004–05 was Rs. 1201 of which the share of
public was Rs. 242 (20.18%) and that of
private was Rs. 959 (79.82%). (NHA 2004-05)
Inequity in rural-urban allocation by state
and central govt.
Majority exp by private sector
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31. Public exp. on health as % of
total govt exp.
The share of public expenditure in GDP has
increased to 1.10% in 2008–09 from 0.96% in
2005–06. and again decrease to 1.04 in 2011-12.
Even this small public expenditure is skewed
towards the richer groups, particularly those living
in urban areas
Public exp. As share of GSDP <1% for all states.
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32. Public health spending & indicators
Indicators
% population Infant
with income
mortality
< 1 doller/day
% health
expenditure
to GDP
% public
expenditure
to total exp.
INDIA
44.2
70
5
17.3
CHINA
18.5
31
2.7
24.9
SRI LANKA
6.6
16
3
45.4
UK
-
6
5.8
96.9
USA
-
7
13.7
44.1
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36. Share in Healthcare Spending
2005(%)
(World Health Statistics 2008,WHO)
COUNTRIES
Private exp of total
exp on health
OOP of private exp
on health
OOP of total exp on
health
Bangladesh
70.9
88.3
62.6
Brazil
55.9
54.6
30.5
China
61.2
85.3
52.2
India
81
94
76.1
Indonesia
53.4
66.4
35.5
Malaysia
55.2
75.7
41.8
Mexico
54.5
93.9
51.2
Pakistan
82.5
98
80.9
Philippines
63.4
80.3
50.9
Sri Lanka
53.8
86
46.3
South-east Asia
71
90.4
64.2
South Africa
58.3
17.4
10.1
38. Despite poor health indicators, Govt spending on
health care is well below what is needed
Reason being:
– Low revenue collection
– Competing demand for revenue
– Relatively low spending priority
Consequently, limited access to public health care
facilities forces people to go to Pvt. Provider,
resulting in substantial out of pocket (OOP)
spending, specially for the poor.
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39. Around 24% of all people hospitalized in India in
single year fall below the poverty line due to
hospitalization (WB, 2002)
Those in the bottom four income quintile borrow
money or sell assets to pay for hospitalization.
(WB, 2002)
OOP expenditure needs
to be reduced as it
aggravates the inequities
by impoverishing the poor
further.
Therefore, the role of
the Govt. assumes
importance in this
context.
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40. Of the total OOP expenditure by household in
2004–05: rural - 62% ; urban - 38%
Among various components highest expenditure
was incurred on medicine both in public and
private health care institutions
– public health care - 66% of expenditure in rural areas
& 62% in urban areas.
The component wise analysis showed that about
Out patient care - 66.10%
In patient care - 23.48%,
Delivery - 3.43% and on
Family planning services - 2.83%.
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41. Reasons of Rising OOP Exp.
A major expenditure item is drugs:
– With the patent regime and the deregulation of
administered pricing regime,
– Irrational use of drugs
– Prices of new drugs and
– Drugs for many NCDs - unaffordable to majority of
the poor
– Non availability of drugs to outpatient & inpatient in
the public sector.
Doctor’s fee was another critical component.
Non availability of investigation facility in public
sector
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42. Three drives of cost escalation in health
care system.
1.Resources for health care
2.Efficacious and affordable drug regime
3.Access and availability to appropriate
technology
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43. % of Household falling to BPL
NSSO 2004
Inpatient
Outpatient
Total
Rural
1.3%
5.3%
6.6%
Urban
1.2%
3.8%
5.0%
Total
1.3%
4.9%
6.2%
44. Health expenditure by functions
Sr no.
Health Care Functions
% Distribution
1
Tertiary care
22.45
2
Secondary care
15.32
3
Primary care (41.26)
a) SC/PHC/Dispensaries
b) Public Health programme
11.27
c) Family welfare
13.04
d) Rehabilitative care
4
16.58
0.38
Direction and Administration
10.07
Health statistics and research
2.25
6
Medical stores
1.76
7
Medical reimbursement/compensation
4.13
Functions not specified
2.76
Total
100
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45. Health expenditure by functions
Sr no.
Health Care Functions
% Distribution
1
Curative Care
42.67
2
Rehabilitative & Long term Nursing Care
0.28
3
Ancillary Services related to Medical Care
2.33
4
Medical Goods Dispensed to Outpatients
0.92
5
Prevention and Public Health (20.79) Services
1. RCH & Family welfare
12.07
2. Control of communicable diseases
6.82
3. Control of NCDs
0.91
4. Other public health activities
0.98
6
Health Administration & Insurance
9.69
7
Health & related functions (17.3)
1. Medical Education and Training of Health Personnel
2. Research and Development
5.33
4. Nutrition Programme
0.08
5. Food Adulteration & Control
9
2.03
3. Capital Formation
8
9.56
0.30
Functions from other Sources
4.99
Functions not Specified
1.1
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46. Health insurance
Mutual support system based on notion that “ I will
help you in your current need , you to give me help
when I need it.
Insurance : means it ensures every individual
contributors that they don’t have to pay full cost of
care out of pocket in the event of illness
16 % population covered by any form of insurance.
Types:
Social health insurance
Private health insurance
Community based health insurance
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47. Social Health Insurance
ESIS :
Supplemented by the Central and State governments.
Its own network of dispensaries and hospitals, supplemented
by some outsourced Authorized Medical Attendants and
private hospitals.
Also has ‘Cash Benefits’ which compensate for loss of wages
due to disease/ disability/ death.
Covers over 50 million persons presently.
CGHS :
Covers 3.2 million persons. It has its own dispensaries while
hospital services are outsourced.
Both provide comprehensive ambulatory and hospital
care without any annual limits.
48. Community Health Insurance
Small schemes, community-based and not-for-profit motive.
Managed by community members, and accountable back to
members.
‘Facilitators’, usually NGOs, may play an important role.
May outsource part (or all) of risk and/or health services
provision through tie-up with hospitals, insurers.
Gujarat: Self Employed Women’s Association (SEWA)
Maharashtra: Sewagram, Wardha
Gujarat: TribhuvandasFoundation (TF), Anand
49. Private Health Insurance
Voluntary health insurance scheme, with over 300
products from over 30 insurers competing in the market
today.
Exclusions, wait periods, sub-limits and other policy
conditions are structured by insurers to avoid adverse
selection, information asymmetry and moral hazard. Not
well understood by customers-issue of confidence.
Cover about 60 million people presently (excluding
Government-funded schemes), roughly equally shared
between Corporate (group) insurance plans and Retail
(individual/family) plans.
TPA to facilitate speedier expansion by providing an
administrative-intermediary.
50. State Health Insurance Scheme
Rajiv Arogyashri - AP
Kalaignar -TN
Vajpayee Aarogyashri- KA
Yeshaswini -KA
51. User fees/community financing
User fees: Any payment made by beneficiaries
directly to the health care service providers at the
time of delivery of health care services
Alternative cost recovery mechanism of health
financing
Mudaliar committee : 1st advocated levying of
small fee on availing hospital services, except poor
NHP 2002 : recognize the practical need for user charges
Obj :To generate ‘revenue’ for ‘cost recovery’
When the community pays for services, it learns to
demand and value them (remove unnecessary demand)
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52. Currently, almost all states in India have
introduced user fee in Govt. health facility for
people above poverty line.
The collected revenue is deposited in Govt.
treasury or used for improving those facility.
Few states formed society to collect and utilize
fund locally.
Implications:
–
–
–
–
–
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Increase efficiency of health services
Remove the long queue for free health care services.
Improve equity
Improve quality of services
sustainable
52
53. Initiative by GOI
At National level
NRHM
RSBY
At State level
State health insurance
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54. NRHM
Launched in 2005 – to provide universal access to
equitable, affordable and accountable quality health care
Better staffing as per IPHS and human resource
developmental policy, untied fund etc.
Rogi kalyan samiti
User charges started at CHCs and higher level hospital.
Bottom up approach has adopted
During 11th plan there was 4 fold increase in budget
allocation to health sector. Out of this 65.7% was proposed
for NRHM.
In 12th plan, there has been more than two fold increase
over 11th plan budget.
But failed to achieve 2-3% of GDP.
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55. Rashtriya swasthya bima yojana
It is a central Govt. health insurance scheme to meet
the health needs of the poor
Centre: state – 75 : 25. in North east 90:10.
The maximum premium by the central Govt. is
limited to 750 per insured family/yr.
Benefits:
–
–
–
–
–
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Hospitalization expenses upto Rs 30,000
Maternity newborn care
Day care services
Transportation cost (Rs.100/visit, limit of 1000/yr)
Cover all preexisting diseases
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56. 12th plan initiative
Universal health coverage
Private sector has to be partnered for health care
delivery.
Government Sponsored HIS should enroll private
providers for in-patient care & ambulatory care,
via ‘contracting-in’ mechanism
Essential Medicine List needs to be brought under
price control mechanism,
Incentivization of states
Flexibility in central funding for state
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57. Other Models of financing
Public private partnership (PPP)
Medical Tourism
FDI in Health sector
Resource generation by Facilities and
colleges
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58. Medical tourism
India’s medical tourism is also booming
It is the provision of cost effective medical care
with due consideration to quality for foreign
patients who need specialized treatment surgery
Indian health market growing at a rate of 30%
annually. Medical tourism alone can contribute Rs
5000 to 10,000 crore additional revenue by 2012 &
will account for 3-5% of the total health care
delivery market.
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59. Challenges
PPP: cost escalation. Invariably expensive drugs and
procedures are prescribed.
Insurance companies provide health cover to the young, the
employed and the rich, and avoid those who are elderly,
unemployed and poor.
There is a cozy relationship between the insured, the
insurance company and the healthcare provider.
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60. Challenges
Insurance covers only the cost of hospitalisation and not
expenditure on outpatient care. NHA statistics show that
close to 70 per cent of the out-of-pocket expenditure of the
household is for outpatient care, which will not be covered
by insurance.
In the Indian situation where a majority of the people are
self-employed, universal coverage will remain a mirage
Many villages in India do not have a hospital worth the
name within accessible distance. What use would insurance
cover be for people living there?
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61. Recommendations
The future has to be tax funded. Preventive,
primary and some part of secondary treatment has
to be completely free, cashless and provided by
the government and funded through taxes.”
Systems to track & audit expenditures against
budget authorization
Community based research for credible burden of
disease.
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62. Recommendations
Develop public private partnership.
Increase spending on health promotion: 10%- 20%
Rationalizing & restructuring public health
delivery system.
Integrating AYUSH-increase in human resource.
Raise additional resources by imposing taxes on
health degrading products, eg, tobacco.
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63. References
National Commission on Macroeconomics & Health 2005.
World Health Report 2003
Trends in healthcare financing 2010
National Account Statistics
NSSO and Consumer Expenditure GoI
Healthcare in India: Changing the Financing Strategy
Financial Resource Management (Nihfw) Module
Health Policies and Programmes in India, Dr D K Taneja
National Health Programmes of India, Dr J Kishore
Shivakumar A K, chen L C, chaudhary M et al Financing
health care for all: challenges and opportunities. Lancet
2011; 377: 668–79.