Total healthcare expenditure was 4.3 % of GDP, below the LMIC average of 5.3%. More importantly, Health insurance covered only 5% of
Indian healthcare sector faces shortage of workforce and infrastructure. India has 1.7 trained allopathic doctors and nurses per 1,000
population compared to WHO recommended guideline of 2.5 per 1,000 population.
India’s Infant Mortality Rate, Maternal Mortality Ratio and Life Expectancy lags behind average of low and middle income countries.
Current Condition in India
Why do we need to improve Healthcare?
“ Health is an input into EconomicDevelopment of a
Over 25% of hospitalizedIndians fall below poverty
line because of hospital expenses
Over 40% of hospitalizedIndians borrowheavily or
sell assets to cover expenses
Hospitalized Indians spend 58% of their total annual
expenditure on health care
Only 10% Indians have some form of health
Health Indicators continue to lag.
HealthCare spend is not growing at same pace as GDP.
Out of pocket spending continues to be high.
Infrastructure gaps remain substantial, and are
exacerbated by underutilization of existing resources.
Health workforce remains inadequate and underutilized.
While regulatory systems have been partially defined, a
holistic regulatory framework is required.
Public-private collaboration has not yet achieved scale.
MAJOR CHALLENGES BEFORE INDIA
In last few years, India’s health system developed well in few areas. Public sector efforts gained momentum with adoption of MDGs, as
Govt. had set targets to reduce the MMR by three quarters between 1990 and 2015; to halt the spread of HIV /AIDS, malaria and other
major diseases; and to revise their spread by 2015.
The focus needs to be on efficiency, especially through better utilization. Government should ideally choose between the payer
or provider role. Large scale implementation needs strengthening. A decentralized federal system functions effectively when
supported by a common policy framework.
Prevention and early stage management should be a core focus area. Creating universal access has to be a primary focus, with a
secondary focus on efficiency or quality.
An all-encompassing vision of future demand for health services should guide this vision and roadmap for Indian health system.
Transforming the health system is a long-term journey, championed and driven by political leadership over a sustained period.
A constructive and transparent dialogue will be needed between the public and private sectors at this early stage of the journey.
To collaborate with the private sector, government would need an inclusive vision, dialogue and an effective regulatory
THE ROAD AHEAD
Raising an Army of
Primary Health Care
Taluk / Block Level
for Curative Care
Raising an Army of Community Health Workers
Honorarium of Rs.1000 / month
Accountable to village Panchayat
3 months’ training (Union) + health kit + refresher courses
Urban Health Worker (UHW) in areas inhabited by low income
and poor populations.
One VHW per 1000 population (a million gainfully employed)
Women from the community
Training: Rs. 200 Crore per year for training of
VHWs/UHWs, spread over three years.
Borne by the Union
Honorarium: Rs. 1200 Crore per annum
(shared equally by Union and states)
Health kits: Rs. 100 Crore per annum for a few
generic drugs etc.
(shared equally by Union and states)
Refresher workshop: Rs. 50 Crore per annum – 2
refresher workshops – 3 days each
(shared equally by Union and states)User charges as prescribed by Panchayat
Incentives for performance
Strengthening of Primary Healthcare Delivery System
Up gradation of PHCs in order to provide 24 hour delivery services
New programmes for the control of non-communicable diseases
Urban health posts
Intensification of ongoing communicable disease control programs
Provisioning of 35 essential drugs in all PHCs
Direct Union Financing of Male MPWs
Addressing shortage of other paramedical staff
Addressing shortage of doctors in 8 states
Male MPWs - Rs. 828 Crore/year
Intensification of on-going disease control programs
- Rs. 500 Crore/year
Supply of listed drugs - Rs. 500 Crore/year
Urban health posts - Rs. 200 Crore/year
Control of non-communicable Diseases
- Rs. 260 Crore/year
Up gradation of PHCs for 24-hour delivery
– Rs. 480 Crore /year
Supply of auto-destruct syringes – Rs. 60 Crore /year
National Mission for Sanitation
50 million units with private funds + 50 million with
100 million toilets in 5 years
A toilet for every household
Health, hygiene, dignity and aesthetics
Great Sanitation Movement 50 million toilets - Rs. 12,000 Crore – (One-Time allocation)
Union’s Share : Rs 8,000 crore, States Share : Rs. 4,000 Crore
Spread over 5 years for 10 million toilets a year, i.e., Rs
1600 Crore per year for the Union and Rs. 800 crore per
year for all states put together.
Annual fund requirement for 5 years : Rs. 2400 Crore.
In addition, a national public health education program
and propagation of technology may cost Rs 100 Crore
per year. The Union may take up this campaign.
Total fund requirement for 5 years: Rs. 2500 Crore/ Year
Taluk/Block Level Referral Hospitals
for curative care
Capital cost of 7000 CHCs at Rs. 1 crore each: Rs. 7000 Crore
Annual cost (spread over five years): Rs. 1400 Crore
Recruitment, appointment, control and financial provision by
Local Government, with full assistance from State and Union
Governments in the form of grants
To be controlled by the local government
(District Panchayat or Town/City Government)
One 30-50 bed referral hospital for every 100,000 population
Staff – One Civil Surgeon, 3 or 4 Civil Assistant Surgeons, a
dentist, 7 or 8 staff nurses and 2 paramedical personnel
Encourage public-private partnerships
Ensure choice to patients among multiple service providers
Encourage competition among health care providers
Create incentives and risk-reward system to promote quality
health service delivery
Ensure access and quality of service to those with no influence
Raise resources innovatively & make the program sustainable.
Strengthen public health care
Health Insurance: Objectives
Risk Pooling and Hospital Care Financing
National health insurance will further strengthen
private providers at the cost of public exchequer
Public health system is in disarray
Most of the disease burden is a consequence of failure
of primary care
Traditional health insurance is not an answer for
health care requirements of poor
Risk-pooling: from Union and states : Rs. 6000 Crore / Annum
Less current maintenance cost of
public hospitals (estimated) : Rs. 3500 Crore / Annum
Additional Requirement * : Rs. 2500 Crore / Annum
Community Based Health Insurance : Rs. 100 Crore / Annum
Total Rs. 2600 Crore / Annum
* Rs. 3000 Crore will be raised separately as local taxes.
Risk Pooling and Hospital Care Financing
Reimbursement will be based on standard costs and services
Patients will have a choice to visit any public hospital. The
public hospital care costs will be reimbursed by DHB / money
follows the patient.
Pooling of the money at the District level with a new
authority – District Health Board (DHB) under the overall
umbrella of elected local governments
Citizens’ share to be collected by the local governments as
Financing by the Union, State and citizens (those above
poverty), pooling Rs. 90-100 per capita
This will be the precursor of a National Health
Service which serves all people at low cost
There will be regular health accounting to trace expenditure flows,
analyze costs and benefits, and demand and supply
Patients can go to tertiary hospitals only in emergencies or upon
referral by secondary care hospitals
A part of the fund (15% ) will be separately administered for
tertiary care / teaching hospitals at the State level
A phased program will be evolved for existing public hospitals to
give time for transition.