Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place.
Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies
Expand the array of health care providers
Improve the access to health care specialists
Improve the quality of health care
Give more care to citizens
Decrease the cost of health care
MAJOR GOAL Getting better/ more health care protection for as many people as possible at the lowest possible cost.
EVOLUTION OF HEALTH CARE CHANGES
MEDICINE IN ANTIQUITY. DAWN OF SCIENTIFIC MEDICINE MODERN MEDICINE
MEDICINE IN ANTIQUITY. In ancient times, health and illness were interpreted in a cosmological and anthropological perspective. Medicine was dominated by magical and religious beliefs which were an integral part of ancient cultures and civilizations.
1. PRIMITIVE MEDICINE
Evidence from cave art, daring back at least 30,000 years, suggests caves were used for magical ritual purposes. Shamans were considered as the head of conducting rituals
Primitive medicine frequently performed a type of brain surgery that we today call trephination. Trephination was done by using stone instruments to bore or grind holes in the skull
2. TRIO INDIAN MEDICINE
The practicals fields of Ayurveda are divided into eight sections or branches. These sections are: internal medicinal, surgery, cranial organo medicine, pediatrics, toxicology, rejuvenating remedy, aprodisiac remedy and spiritual healing. These eight sections are called "AstangaAyurveda.
The Siddha medicine is a form of south Indian Tamil traditional medicine and part of the trio Indian medicines - ayurveda, siddha and unani. This system of medicine was popular in ancient India. The system is believed to be developed by the 18 siddhas in the south called siddhar.
Unani-tibb or Unani Medicine its origin to Greece. It was the Greek philosopher - Physician Hippocrates (460-377 BC) who freed Medicine from the realm of susperstition and magic, and gave it the status of Science. The theoretical framework of Unani Medicine is based on the teachings of Hippocrates
The Greeks taught men to think in terms of why and how. The medical historian, Douglas Guthrie has reminded us of the legend that Hygiea was worshipped as the goddess of health and Panacea as the goddess of medicine. Panacea and Hygiea gave rise to dynasties of healers (curative medicine) and hygienists (preventive medicine) with different philosophies. Greatest physician in Greek medicine was Hippocrates who is often called as the father of medicine.
II. DAWN OF SCIENTIFIC MEDICINE
Revival of medicine
Rise of public health
Germ theory of disease
Birth of preventive medicine
GERM THEORY OF DISEASE-LOUIS PASTEUR
III. MODERN MEDICINE
CHANGING CONCEPTS IN PUBLIC HEALTH .
Disease control phase(1880-1920)
Health promotional phase(1920-1960)
Social engineering phase.
Health for all phase
HEALTH CARE REFORMS IN INDIA
1. COMPREHENSIVE CARE
The Bhore committee (1946)defined comprehensive health care as the following criteria. Provide adequate preventive, curative and promotive health services. Be as close to the beneficiaries as possible. Widest cooperation between the people, the service and the profession. Is available to all irrespective of their ability to pay Look after specifically the vulnerable and weaker sections of the community. Create and maintain healthy environment both in home as well as working places.
2. BASIC HEALTH SERVICES.
A basic health service is understood to be a network of coordinated, peripheral and intermediate health units capable of performing effectively a selected group of functions essential to the health of an area and assuring the availability of competent personnel and auxiliary personnel to perform these functions.
3. PRIMARY HEALTH CARE
Before Alma Ata primary health care was regarded as synonymous with basic health services, first contact care, easily accessible care , services provided by generalist…
The Alma-Ata international conference gave primary health care a wider meaning Primary health care is essential health care made universally accessible to individuals and acceptable to them , through their full participation and at a cost the community and country can afford.
Principles of Primary health care.
Inter sectoral coordination
HEALTH FOR ALL
In 1977, it was decided in the World Health Assembly to launch a movement known as health for all by the year 2000. The fundamental principle of HFA strategy is equity that is an equal health status for people and countries ensured by an equitable distribution of health resources.
In 1978, Alma Ata international conference on Primary health care reaffirmed Health for all as the major social goals of the Governments and stated that the best approach to achieve the goal of HFA is by providing primary health care, especially to the vast majority of underserved rural areas.
In 1981, a global strategy for HFA was evolved by WHO. The global strategy provides a global framework that is broad enough to apply to all Member states
MILLENIUM DEVELOPMENT GOALS.
September 2000, representatives from 189 countries met at the millennium summit in Newyork, to adopt the United Nations Millenium Declaration. Goals :Area of development and eradication of poverty.
ISSUES IN HEALTH CARE REFORMS.
1. UNEQUAL DISTRIBUTION OF HEALTHCARE RESOURCES INDIA.
The ratio of hospital beds to population in rural areas is fifteen times lower than that for urban areas.
The ratio of doctors to population in rural areas is almost six times lower than that in the urban population.
Per capita expenditure on public health is seven times lower in rural areas, compared to government health spending for urban areas.
The most peripheral and most vital unit of India’s public health infrastructure is a primary health centre (PHC).
In a recent survey it was noticed that only 38% of all PHCs have all the essential manpower and only 31% have all the essential supplies (defined as 60% of critical inputs), with only 3% of PHCs having 80% of all critical inputs.
Though the spending on healthcare is 6% of gross domestic product (GDP), the state expenditure is only 0.9% of the total spending. People using their own resources spend rest of it. This makes the Indian public health system grossly inadequate and under-funded.
Only five other countries in the world are worse off than India regarding public health spending (Burundi, Myanmar, Pakistan, Sudan, Cambodia). As a result of this dismal and unequal spending on public health, the infrastructure of health system itself is becoming ineffective.
2. ACCESS DIFFICULTIES TO HEALTH CARE.
A different aspect of healthcare access problem is noticed in cases of ‘urban poor’.
Urban residents are extremely vulnerable to macroeconomic shocks that undermine their earning capacity and lead to substitution towards less nutritious, cheaper foods.
People in urban slums are particularly affected due to lack of good housing, proper sanitation, and proper education
Urban slums are also home to a wide array of infectious diseases (including HIV/AIDS, tuberculosis, hepatitis, dengue fever, pneumonia, cholera, and malaria) that easily spread in highly concentrated populations where water and sanitation services are non-existent.
Poor housing conditions, exposure to excessive heat or cold, diseases, air, soil and water pollution along with industrial and commercial occupational risks, exacerbate the already high environmental health risks for the urban poor.
Lack of safety nets and social support systems, such as health insurance, as well as lack of property rights and tenure, further contribute to the health vulnerability of the urban poor.
Though the healthcare facilities are overwhelmingly concentrated in urban areas, the ‘socio-economic distance’ prevents access for the urban poor. These socio-economic barriers include cost of healthcare, social factors, such as the lack of culturally appropriate services, language/ethnic barriers, and prejudices on the part of providers. There is also significant lack of health education in slums.
Gender related distance.
From socio-cultural and economic perspectives women in India find themselves in subordinate positions to men.
They are socially, culturally, and economically dependent on men.
Women are largely excluded from making decisions, have limited access to and control over resources, are restricted in their mobility, and are often under threat of violence from male relatives.
3. EFFECT ON HEALTH OUTCOME INDICATORS DUE TO ECONOMIC INEQUALITY
Healthy living conditions and access to good quality health care for all citizens are not only basic human rights, but also essential prerequisites for social and economic development.
Any inequality in social, economical or political context between variouspopulation groups in a given society will affect the health indicators of that particular society.
4. PRIVATE HEALTHCARE AND ECONOMIC INEQUALITY
The growth of private healthcare sector has been largely seen as a boon, however it adds to ever-increasing social dichotomy. The dominance of the private sector not only denies access to poorer sections of society, but also skews the balance towards urban-biased, tertiary level health services with profitability overriding equality, and rationality of care often taking a back seat.
The increasing cost of healthcare that is paid by ‘out of pocket’ payments is making healthcare unaffordable for a growing number of people. The number of people who could not seek medical care because of lack of money has increased significantly between 1986 and 1995
The proportion of people unable to afford basic healthcare has doubled in last decade.
One in three people who need hospitalization and are paying out of pocket are forced to borrow money or sell assets to cover expenses.
Over 20 million Indians are pushed below the poverty line every year because of the effect of out of pocket spending on health care.
In the absence of an effective regulatory authority over the private healthcare sector the quality of medical care is constantly deteriorating.
RESEARCH ARTICLE. A recent World Bank report acknowledges the facts that doctors over-prescribe drugs, recommend unnecessary investigations and treatment and fail to provide appropriate information for patients even in private healthcare sector. The same report also states the relation between quality and price that exists in the private healthcare system. The services offered at a very high price are excellent but are unaffordable for a common man. This re-emphasizes the role socio-economic inequality plays in healthcare delivery.