Health Care Reforms in India - BAckground, definition, components, Indian scenario

1. Health Care Reforms
in India

2. Concept
Health System
"combination of resources,
organization, financing, and
management that culminates
in the delivery of health
services to the population"
Health Care
Health care, health-care, or
healthcare is the maintenance or
improvement of health via the
prevention, diagnosis, treatment,
recovery, or cure of disease,
illness, injury, and other physical
and mental impairments in
people.
Reforms
‘Fundamental rather than an incremental change, which is sustained rather than
one off, and also purposive’
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3. The key institutional components of the health system are
– State or Government institutions
– Health care providers
– Resource institutions
– Purchasers of health care such as insurance agencies
– Other sectoral agencies e.g., education, water supply,
sanitation
– Consumers or population at large
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4. Background
▪ Health sector reforms have generated much debate in
India, especially in the context of economic liberalization.
▪ The World Bank intensified this debate in 1993 when it tried
to redefine the role of the public and private sectors in
healthcare.
▪ There is no consistent and universally accepted definition
of what constitutes Health Sector reforms thereby leading
to varied meaning and connotations.
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5. Definition
▪ “Sustained purposeful change to improve the efficiency, equity
and effectiveness of the health sector” – Peter Berman (1995)
▪ “Defining priorities, refining policies and reforming the
institutions through which those policies are implemented” –
Cassels (1997)
▪ Sustained process of fundamental change in policy and
institutional arrangements of the health sector, usually guided by
the Government to improve the functioning and performance of
the health sector and ultimately the health status of the people -
WHO 5

6. Introduction
▪ Changes that affect at least two of these elements:
▫ health financing
▫ Expenditure
▫ Organization regulation o Consumer behavior.
If we change only health financing its not health sector
reform
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7. Introduction
▪ In recent years, economic pressures on the government and
specifically on the health sector have forced the governments
of developing countries to initiate health sector reforms.
▪ This thrust is made to ensure that an appropriate share of
public funds is spent on health care, especially at local levels
(allocative efficiency).
▪ It is designed to improve the organization and management
of health systems and ultimately to achieve overall health
policy objectives.
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8. Introduction
▪ The users should also be satisfied with the form and
content of health services offered (improved health
status and client satisfaction), and that the benefits of
publicly-funded health care are equitably distributed
(improved equity of access to care).
▪ These health sector reforms varied in social, economic
and political environments, as well as in development
stages of health care systems
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9. Components of HSR
– Equity
– Effectiveness
– Efficiency
– Quality
– Sustainability
– Defining priorities
– Refining the policies
– Reforming institutions for policy implementations. 9

10. Basis of Indian Health policy
1. Assumption – PHC is basic right
2. Health facilities based on population size
3. Provisions under various laws
4. Inaccessibility to the weaker section of society
5. Nationwide low rate of health care utilization rate
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11. Nature of Health Sector reforms
1. HSR and public spending
2. Structural adjustment programme –WB & IMF
3. Growth on principle of the market
4. 1990s LPG – private investment in health sector
5. Privatization is at the core of reforms
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Purpose of Health care reforms
1. To have the population receive health care coverage through
either public sector insurance programs or private sector
insurance companies
2. To expand the array of health care providers
3. To improve the access to health care specialists
4. To improve the quality of health
5. To provide more care to citizens
6. To decrease the cost of health

13. Types of Reforms
 Changes in financing methods
 Changes in health system organization and Management
 Public sector reforms
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Health care reforms cycle

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16. Principles of Health Care Reforms
 Make certain that patients are empowered to control and
decide how their own health care dollars are spent
 Ensure unencumbered access to specialty care
 Make health care coverage more affordable
 Improve the quality of care
 Extend both coverage and access for the uninsured and under-
insured
 Avoid establishing new unsustainable programs
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17. Indicators of Health Care Reforms
 Permission to foreign providers of medical care
 Encourage private health insurance industry
 To lease spare capacity in public facilities to private practitioners
 Loan to practitioners to render services in rural area
 Regulatory framework for the private sector
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18. Strategies
 Alternative financing
 Institutional management
 Public sector reforms
 Collaboration with private sector
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19. Challenges to reforms
Unclear who has the power and responsibility.
• The minister for health?
• The medical association?
• The health insurers?
• The citizens?
• Power divided among groups - interests ?
• Doctors want more freedom and more resources
• Health insurers want more control and less spending
• Ministers want quick changes
• Public health specialists’ focus is health promotion
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20. India
▪ About 7% of Indians are pushed into poverty each year
due to unaffordable health care
▪ Only 27% of the population is covered by health
insurance
▪ Child mortality rate 32-1000
▪ Mother mortality rate 212-100000
▪ 30% children are underweight
▪ Anemia = Children 59%, 52% Women 20

21. India
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22. India
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23. India
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24. India
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25. India
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27. HSR IN INDIA
▪ Health sector reforms have come center stage since 1980s
essentially from frustration of the citizens in receiving any
semblance of health care from the public system. By 1990s the
process had taken concrete shape.
▪ In India, the health sector reforms broadly cover the following
areas : –
▫ Re organisation and restructuring of existing health care
system
▫ Involving Community in health service delivery
▫ Health Management Information System
▫ Quality of care 27

28. HSR: AREAS
▪ Decentralization •
▪ Human Resources •
▪ Financial reforms •
▪ Reorganization and restructuring of the existing health system •
▪ Health Management Information Systems •
▪ Communitization •
▪ Quality assurance •
▪ Convergence •
▪ Public Private Partnership 28

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31. HRS and WHO'S ROLE
▪ The World Health Organization, through its various
collaborative programmes at all levels, is involved in
capacity building in the member Countries to take care
of the evolving reforms in the health sector, mainly in
the areas of planning and human resources.
▪ To support the reforms processes in countries, a series
of publications, both at regional and global levels, have
been issued.
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32. HRS and WHO'S ROLE
▪ An international "Forum on health sector reforms" has been
established to share and disseminate information on the
scope and nature of WHO's current and planned activities in
support of health sector reforms and in identifying priority
issues, reviewing country experiences and also the
approaches of different agencies in the field.
▪ WHO is also supporting institutional strengthening to
promote expertise in the developing countries.
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34. IMP Take away
▪ Reforms are purposeful efforts to change system.
▪ Reforms have to be rational, logical and specific.
▪ It is political process.
▪ Reforms should take place as a sustained process of
fundamental change in health policy and health institutional
arrangements.
▪ Sustained information and education are needed to generate
wider political and public understanding and support.
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