INDIA, US, UK HEALTHCARE SYSTEMS - AN OVERVIEW

1. INDIA, US & UK HEALTH
CARE SYSTEMS
A SMALL BRIEF
B LEELA DHAR
MDHM (OU) 2014-16; AIHA
ROLL NO 1404-01-676031
(INDIA)94904-68518;
BOBBALEELADHAR@HOTMAIL.COM

2. INTRO

4. QUIZ
(30 seconds)

14. HEALTH CARE SYSTEMS
B LEELA DHAR
ROLL NO- 31
MHM 2014-16
24 SEP 2014

15. KNOW ABOUT
UNITED STATES OF AMERICA

18. Capital Washington, D.C. - 38°53 N 77°01 W [4]′ ′
Government Federal Presidential Constitutional Republic
President - Barack Obama
Independence from Great Britain - July 4, 1776
Area - 96,29,091 km2
Population – (2014 estimate) 31,87,76,000
Density - 34.2/km2 (180th)
GDP 2014 estimate $17.528 trillion (1st)
Per capita $54,980 (9th)
Currency United States dollar ($) (USD)
WORLD’S LARGEST NATIONAL ECONOMY.
14.5% UNDER POVERTY ONLY.
23% OF GLOBAL NOMINAL GDP.
19% PURCHASING POWER PARITY.

19. KNOW ABOUT
UNITED KINGDOM

21. Capital and largest city – London 51°30 N 0°7 W [3]′ ′
Government Parliamentary Constitutional Monarchy
Monarch Elizabeth II
Prime Minister David Cameron
Legislature Parliament
Area - 2,43,610 km2 (80th)
Population - 2011 census 6,31,81,775 (22nd)
Population Density 255.6/km2 (51st)
GDP 2014 -$2.828 trillion (6th)
Per capita $43,830 (21st)
78th-largest sovereign state
22nd-most populous country
World's first industrialised country
The foremost power during the 19th and early 20th centuries.
The UK remains a great power with considerable economic, cultural, military,
scientific, and political influence internationally

22. KNOW ABOUT
INDIA

24. Capital - New Delhi [28°36.8 N 77°12.5 E ]′ ′
Largest city - Mumbai
Government Federal parliamentary
Area - 3,287,590 km2 (7)
Population – (2011 census ) 121,01,93,444 (2nd)
Density 379.6/km2 (31st)
GDP (PPP) 2014 estimate
Total $5.425 trillion (3rd)
Per capita $4,307 (133rd)
GDP (nominal) 2014 estimate
Total $1.996 trillion (10th)
Per capita $1,584 (143rd
)

25. AIM

26. TO ACQUAINT THE
CLASS WITH THE
HEALTH CARE
SYSTEMS OF US & UK
AND REVIEW THEM
WITH REFERENCE TO
OUR INDIAN HEALTH
CARE SYSTEM

27. PREVIEW

28. PART 1 - US HEALTH SYSTEM
PART 2 -
UK HEALTH SYSTEM
(NHS)
PART 3 -
POINTS TO PONDER BY
COMPARING WITH OUR
OWN INDIAN HEALTH
SYSTEM
PREVIEW

29. PART 1
US HEALTH SYSTEM

30. MANPOWER
14.4 MILLION
DRs (MD)
 DOs
NURSES
 DENTISTS
PHARMACISTS &
 ADMINISTRATORS
382,000 PERS
REHABILITATION
SERVICE PERSONNEL
INVOLVED IN
PHYSICAL,
OCCUPATIONAL AND
SPEECH THERAPISTS
US HEALTH SYSTEM
HEALTH CARE CENTERS
5,700 Hospitals.
15,900 Nursing Homes.
2,900 Inpatient Mental Health
Facilities.
11,000 Home Health Agencies.
 TRAINING INSTITUTIONS
144 MEDICAL AND OSTEOPATHIC
SCHOOLS.
56 DENTAL SCHOOLS.
109 PHARMACY SCHOOLS.
1,500 NURSING INSTITUTIONS.

31. 800 GOVT PROGRAMS TO COVER
BASIC HEALTH SERVICES FOR MIGRANT WORKERS.
THE HOME LESS.
COMMUNITY HEALTH WORKERS,
BLACK LUNG CLINICS.
HIV INTERVENTION CENTERS.
INTEGRATED PRIMARY CARE & SUBSTANCE ABUSE TREATMENT
US HEALTH SYSTEM

32. US HEALTH SYSTEM
MANAGED CARE SECTOR
ORGANISATIONS
405 LICENSED HEALTH MAINTAINENCE ORGANISATIONS (HMOs)
925 PREFERRED PROVIDER ORGANISATIONS (PPOs)
COVERAGE.
201.7 MILLION – PRIVATE HEALTH INSURANCE COVERAGE.
40.3 MILLION – MEDICARE BENEFICIARIES.
38.3 MILLION MEDICAID RECIPIENTS.
INSURANCE COMPANIES AND PLANS.
 COMPANIES - APPROX 1000.
 PLANS - 70 BLUE CROSS/SHIELD.

33. US HEALTH SYSTEM
NO UNIVERAL HEALTH CARE DELIVERY SYSTEM.
NO OF “MULTIPLE SUB-SYSTEMS” DEVELOPED
THROUGH MARKET FORCES AND POPULATIONS SEGMENTS.
IT IS A MANAGED CARE SYSTEM OF HEALTH
CARE.
SOME OF EFFECTIVE “PUBLIC FUNDED HEALTH
CARE SYSTEM” IS “TRICARE”- A PROGRAM
FINANCED BY MILITARY & “VA (VETERANS
ADMINISTRATION) HEALTH CARE SYSTEM”.

34. US HEALTH SYSTEM – MANAGED CARE SYSTEM

35. US HEALTH SYSTEM – MANAGED CARE
SYSTEM

36. US HEALTH SYSTEM –
CHARACTERISTICSNO CENTRAL GOVERNING AGENCY AND LITTLE INTEGRATION
AND COORDINATION.
TECHNOLOGY DRIVEN DELIVERY SYSTEM FOCUSSING ON ACUTE
CARE.
HIGH ON COST, UNEQUAL IN ACCESS, AVERAGE IN OUTCOME.
DELIVERY OF HEALTH CARE UNDER IMPERFECT MARKET
CONDITION.
LEGAL RISKS INFLUENCE PRACTICE BEHAVIOURS.
GOVERNMENT AS SUSIDIARY TO PRIVATE SECTOR.
MARKET JUSTICE VS SOCIAL JUSTICE : CONFLICT THROUGHOUT
HEALTHCARE.
MULTIPLE PLAYERS AND BALANCE OF POWER.
ACCESS TO HEALTH CARE SERVICES IS SELECTIVELY BASED ON
INSURANCE COVERAGE.

37. US HEALTH SYSTEM – TRICARE
SYSTEMTO ALL ACTIVE MILITARY PERSONNEL OF U.S. ARMY, NAVY, AIR FORCE,
COAST GUARD & SOME UNIFORMED-NON-MILITARY PERSONNELS
BELONGING TO PUBLIC HEALTH SERVICE AND THE NATIONAL
OCEANOGRAPHIC AND ATMOSPHERIC ASSOCIATION (NOAA).
WELL ORGANIZED & HIGHLY INTEGRATED SYSTEM.
COVERS PREVENTIVE & TREATMENT SERVICES.
COMBINES PUBLIC HEALTH WITH MEDICAL SERVICES.
ROUTINE AMBULATORY CARE – MILITARY PERSONNELS PLACE OF
WORK/DISPENSARY/ SICK BAY/ FIRST AID STATION/ MEDICAL STATION.
ROUTINE HOSPITAL SERVICES – AT BASE DISPENSARIES/
SICK BAYS ABROAD SHIP/ BASE HOSPITALS.
COMPLICATED HOSPITAL SERVICES - REGIONAL MILITARY HOSPITALS

38. US HEALTH SYSTEM – VA (VETERANS ADMINISTRATION)
SYSTEM
TO ALL RETIRED VETERAN MILITARY SERVICE PERSONNEL.
(PRIORITY – DISABLED).
ONE OF THE OLDEST (1946) AND FORMALLY ORGANIZED
HEALTH CARE SYSTEM IN THE WORLD.
MISSION – PROVIDE MED CARE, EDU & TRG, RESEARCH,
CONTINGENCY SUPPORT AND EMER MGT FOR DoD MED CARE
SYS.
5.5 MILLION PERSONS COVERED.
1,100 SITES INCL 153 HOSPs, 732 AMB & COMMUNITY BASED
CLINICS, 135 NURSING HOMES, 209 COUNSELLING CENTERS, 47
DOMICILIARIES (RESIDENTIAL CARE FACILITIES), 73 HOME HEALTH
CARE AND CONTRACT CARE PROGRAMMES.
BUDGET $ 30 BILLION & STAFF 2,63,350 (2007 FIGS).
22 GEOGRAPHICALLY DISTRIBUTED VETERANS INTEGRATED
SERVICE NETWORKS (VISNs).

39. PART 2
UK HEALTH
SYSTEM
[NATIONAL HEALTH
SYSTEM]

40. NATIONAL HEALTH SYSTEM
(NHS)
“The NHS belongs to the people. It
provides a comprehensive service,
available to all irrespective of gender,
race, disability, age, sexual orientation,
religion or belief, gender reassignment,
pregnancy and maternity, or marital or
civil partnership status”.
NHS Constitution

41. NATIONAL HEALTH SYSTEM
(NHS)
GENERAL DENTAL COUNCIL – 1,01,901.
GENERAL MEDICAL COUNCIL – 2,52,431.
HEALTH AND CARE PROFESSIONS COUNCIL – 3,10,942.
NURSING AND MIDWIFERY COUNCIL – 6,75,148

42. NATIONAL HEALTH SYSTEM
(NHS)FOUR HEALTH
CARE SYSTEMS
(1948)
NHS IN ENGLAND
NHS IN SCOTLAND
NHS IN WALES
HEALTH & SOCIAL
CARE IN NORTHERN
IRELAND
FIVE DOMAINS
PREVENT PEOPLE FROM DYING
PREMATURELY.
ENHANCING QUALITY OF LIFE FOR PEOPLE
WITH LONG TERM CONDITIONS.
HELPING PEOPLE TO RECOVER FROM
EPISODES OF ILLHEALTH OR FOLLOWING
INJURY.
ENSURING THAT PEOPLE HAVE A
POSITIVE EXPEREINCE OF CARE AND
TREATING AND CARING FOR PEOPLE IN A
SAFE ENVIRONMENT AND PROTECTING THEM
FROM AVOIDABLE HARM.

43. NHS

44. NATIONAL HEALTH SYSTEM
(NHS)

45. NATIONAL HEALTH SYSTEM
(NHS)

46. PART 3
POINTS TO PONDER
BY COMPARING
WITH OUR OWN
INDIAN HEALTH
SYSTEM
(DISCUSSION)

47. INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

48. INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

49. INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

50. INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

51. INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

52. INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

53. INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

54. DISCUSSION
POINTS FOR
PART 3

58. HEALTH SYSTEMS in TRANSITION
( HiT ) IN 2011 BY SEAN
BOYLECONTINUOUS STRUCTURAL
CHANGE – DRAG ON THE SYSTEM.
MECHANISMS SO DEVELOPED FOR
COMMISSIONING HEALTH CARE
WERE NOT EFFECTIVE.
THE INFORMATION WAS STILL NOT
THERE TO ENABLE GOOD SYSTEM
MANAGEMENT AT ALL LEVELS.

60. WIKIPEDIA VERSION ABOUT INDIAN HEALTH SYSTEM
NOMINAL HEALTH CARE SYSTEM.
NOT ENOUGH HOSP, DOCTORS, MED STAFF, MEDICINES OR AMB SER.
QUALITY OF CARE & ACCESSIBILITY POOR. MOST DEPEND ON PVT HOSP.
VERY POOR PEOPLE, DEPEND ON GOVT HOSP. THIS CAN'T BE CALLED A HEALTH CARE
SYSTEM FROM A WESTERN PERCEPTIVE.
THIS NOT AN ORGANISED OR FUNCTIONAL SYSTEM BUT A COLLECTION OF GOVT HOSP
IN DIFFERENT PARTS OF THE COUNTRY TO SERVE A HUGE POPULATION.
INDIA RANKS LAST IN HEALTH CARE COMPARED TO OECD OR BRICS COUNTRIES.
THE 12TH FIVE YEAR PLAN DOCU ON HEALTH HAS RECEIVED A LOT OF CRITICISM FOR
ITS LIMITED UNDERSTANDING OF UNIVERSAL HEALTH CARE AND FAILURE TO INCREASE
PUBLIC EXPENDITURE ON HEALTH.
THE 12TH PLAN DOCUMENT EXPRESS CONCERN OVER HIGH OUT-OF-POCKET (OOP)
EXPENDITURE, BUT IT DOES NOT GIVE ANY TARGET OR TIME FRAME FOR REDUCING THIS .
OOP CAN BE REDUCED ONLY BY INCREASING PUBLIC EXPENDITURE ON HEALTH AND BY
SETTING UP WIDESPREAD PUBLIC HEALTH SERVICE PROVIDERS.
THE PLANNING COMMISSION IS PLANNING TO DO THIS BY REGULATING PRIVATE HEALTH
CARE PROVIDERS.
INSTEAD OF DEVELOPING A BETTER PUBLIC HEALTH SYSTEM WITH ENHANCED HEALTH
BUDGET, 12TH FIVE YEAR PLAN DOCUMENT PLANS TO HAND OVER HEALTH CARE SYSTEM
TO PRIVATE INSTITUTIONS.

61. WIKIPEDIA VERSION ABOUT INDIAN HEALTH SYSTEM
THE 12TH PLAN DOCUMENT EXPRESSES CONCERN OVER RASHTRIYA SWASTHYA BHIMA
YOJANA BEING USED AS A MEDIUM TO HAND OVER PUBLIC FUNDS TO THE PRIVATE SECTOR
THROUGH AN INSURANCE ROUTE.
THIS HAS ALSO INCENTIVIZED UNNECESSARY TREATMENT WHICH IN DUE COURSE WILL
INCREASE COSTS AND PREMIUMS.
THERE HAS BEING COMPLAINTS ABOUT HIGH TRANSACTION COST FOR THIS SCHEME DUE
TO INSURANCE INTERMEDIARIES.
RSBY DOES NOT TAKE INTO CONSIDERATION STATE SPECIFIC VARIATION IN DISEASE
PROFILES AND HEALTH NEEDS.
EVEN THOUGH THESE THINGS ARE ACKNOWLEDGED IN THE REPORT, NO ALTERNATIVE
REMEDY IS GIVEN.
NO REFERENCE TO NUTRITION (AS KEY A COMPONENT OF HEALTH) FOR UNIVERSAL
PUBLIC DISTRIBUTION SYSTEM (PDS) IN THE PLAN DOCUMENT OR HLEG RECOMMENDATION.
IN THE SECTION OF NATIONAL RURAL HEALTH MISSION (NRHM), THE COMMITMENT TO
PROVIDE 30- TO 50-BED COMMUNITY HEALTH CENTRES (CHC) PER LAKH POPULATION IS
MISSING FROM THE MAIN TEXT.
ASHA (ACCREDITED SOCIAL HEALTH ACTIVIST) WORKER, A POOR WOMAN – PAYMENT
INCENTIVE BASED.
DOCTORS, NURSES AND SPECIALIST SLEFT OUT.

62. A PEEP INTO INDIAN HEALTH CARE SYSTEM – FOR FUTURE HOSPITAL MANAGERS

63. A PEEP INTO INDIAN HEALTH CARE SYSTEM – FOR FUTURE HOSPITAL MANAGERS

64. CONCLUSION

66. LIKELY Qs
IN
SEMESTER

67. LIKELY Qs IN SEMESTER

68. LIKELY Qs IN SEMESTER

69. LIKELY Qs IN SEMESTER
1. WE HAVE BEEN RULED BY UK FOR MORE THAN TWO
CENTURIES, FROM WHOM WE INHERITED THE HEALTH
CARE SYSTEM. TODAY THE NHS OF UNITED KINGDOM IS
ONE OF THE BEST HEALTH SYSTEMS IN THE WORLD
WHEREAS OUR INDIAN HEALTH SYSTEM IS NO MATCH.
COMMENT ABOUT THE REASONS AND SUGGEST
MEASURES TO IMPROVE THE EXISTING HEALTH CARE

70. LIKELY Qs IN SEMESTER
2. DISCUSS SIMILARITIES BETWEEN US AND INDIA WITH
RESPECT TO THE HEALTH CARE SYSTEM. SUGGEST
MEASURES TO BRING OUR EXISTING HEALTH CARE
SYSTEM AT PAR WITH US HEALTH CARE SYSTEM OR EVEN
BETTER.

71. CREDITs

72. REFERENCES
&
BIBLIOGRAPHY

73. REFERENCES & BIBLIOGRAPHY
AIHA LIBRARY
INTERNET
FRIENDS

74. SPECIAL THANKS
YOU ALL AUDIENCE FOR LISTENING TO
ME WITH PATIENCE 
PROF AYYAPPU REDDY FOR
GIVING ME AN EXPOSURE &
OPPORTUNITY TO DELIVER THIS
TOPIC 

75. LESS I FORGET
THESE ….
BACK END
PERSONS….
 

76.  THANKS 
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