- Government health spending in India is very low at just over 1% of GDP, well below what is needed to meet the country's health needs. This has forced many people to rely on private healthcare, leading to high out-of-pocket costs that push many into poverty.
- Reforms are needed such as increasing public health spending to 3-5% of GDP, regulating the private sector, and implementing a universal health coverage program. However, challenges remain due to India's large population, infrastructure weaknesses, and need to balance fiscal priorities.
- Initiatives have been launched such as the National Rural Health Mission and health insurance programs, but more focus is needed on primary care, community participation, and direct
Decentralization
Tools of Policy making
Financing Health care
Public-Private Partnership
Health Research
International Organizations
Equity
Health Reforms in Developing Countries
Stake Holders
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 presentation gives a basic introduction to the field of health economics and includes important concepts like that of efficiency, equity, opportunity costs, demand and supply and also includes financial evaluation
Decentralization
Tools of Policy making
Financing Health care
Public-Private Partnership
Health Research
International Organizations
Equity
Health Reforms in Developing Countries
Stake Holders
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 presentation gives a basic introduction to the field of health economics and includes important concepts like that of efficiency, equity, opportunity costs, demand and supply and also includes financial evaluation
Understanding the concept of Universal Health Coverage (UHC) and how can we reach it, both globally and also in India. The presentation also includes HLEG report , which is the proposed architecture for India's guide to reach UHC.
Roadmap for Universal Health Care. FDR, PHFI, and Loksatta are convening a Roundtable of experts, thinkers and practitioners to have a purposive dialogue and help evolve a viable, effective model of universal healthcare delivery in India
This National Health Policy addresses the urgent need to improve the performance of health systems. India today possesses as never before, a sophisticated arsenal of interventions, technologies and knowledge required for providing health care to her people. It is being formulated at the last year of the Millennium Declaration and its Goals, in the global context of all nations committed to moving towards universal health coverage.
Health and health care need to be distinguished from each other for no better reason than that the former is often incorrectly seen as a direct function of the latter. Heath is clearly not the mere absence of disease. Good Health confers on a person or groups freedom from illness - and the ability to realize one's potential. Health is therefore best understood as the indispensable basis for defining a person's sense of well being. The health of populations is a distinct key issue in public policy discourse in every mature society often determining the deployment of huge society. They include its cultural understanding of ill health and well-being, extent of socio-economic disparities, reach of health services and quality and costs of care. and current bio-mcdical understanding about health and illness.
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
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Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
1. DR SUBRAHAMPANY
DEPARTMENT OF COMMUNITY MEDICINE.
INSTITUTE OF MEDICAL SCIENCES & SUM HOSPITAL.
MENTORED BY:
DR. LIPILEKHA PATNAIK.
2. Good health is universally acknowledged to be of intrinsic value & therefore
constitutes an integral element of development.
One can be rich but sick enough to not enjoy any opportunities that wealth opens
up, and poor health may translate into worsening economic opportunities as well.
In fact, one can also be healthy but too poor to pursue valued objectives.
3. DEFINITION OF HEALTH CARE
FINANCING
WHO:
“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.”
4. 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.
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.
5. 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
6. HEALTH SERVICE FINANCING SOURCE
By government.
Health services financed broadly through private
expenditure or public expenditure or external aid.
Voluntary payments by individuals or employers.
External sources refer to the external aid which comes
through bilateral aid Programme or international
NGO’s.
7. BACKGROUND:
India continues to be among the lowest public
health budgets in the world at just over 1% of gross
domestic product (GDP).
And it gets reflected in the performance of the
public healthcare delivery system –decaying
infrastructure, severe staff shortages or
unavailability of medicines.
8. BACKGROUND (CONTD…):
The ineffectiveness of the Indian health system &
characteristically high health-related out-of-pocket
hospital payments have pushed around 60 million
people below poverty line.
Increased spending through National rural health
mission (NRHM) and the focused attention to rural
healthcare are slowly yielding results.
9. BACKGROUND (CONTD…):
Most deliveries across urban and rural areas are now
taking place in government hospitals as pointed to
by data from 2013 sample registration system (SRS).
Given that there are schemes across the country that
offer incentives deliveries in private sector facilities,
this is a remarkable result
11. THE CURRENT NEED.
The current government to meet fiscal deficit targets
are a major cause of worry.
Government should be the primary provider of
healthcare.
A clear roadmap to enhance budgetary spending on
healthcare to 3%-5% of GDP should be drawn.
Regulation of the private sector must be a priority.
12. THE CURRENT NEED(CONTD…).
Establishment of standard treatment protocols and
empowerment of communities to hold the healthcare
system accountable will be critical to ensure quality
of healthcare.
A comprehensive review of currently fragmented
government funded healthcare schemes should be
conducted with the aim of future consolidation for a
13. THE HEART-RENDING SCENARIO
India accounts for the highest number of maternal
deaths in the world, and together with Nigeria (14%),
accounted for one-third of all global maternal deaths.
As a recent review shows, public financing of health is
among the lowest in the world at just over 1% of GDP,
and out-of-pocket (OOP) spending is very high at
around 3% of GDP.
14.
15. • 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.
16. REASONS OF RISING OOP EXP.
• A major expenditure item is drugs:
• 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
8/5/2016 16
17. The National Rural Health Mission aimed to reduce
IMR to 28/1000 live births, the MMR to 100/
100000 live births and the TFR to 2.1 by 2012.
With IMR at 40 and MMR at 167 in 2013, only TFR
seems anywhere near the goal set with 24 of the 29
states and 9 UTS achieving replacement levels of
fertility.
This achievement however is often resulting in
tragic human rights violations in mass sterilisation
THE HEART-RENDING
SCENARIO(CONTD…)
18. HEALTHCARE FINANCING IN INDIA
Over the past few decades, India has made significant
gains in health outcomes.
The crude birth rate, reflecting the huge mortality load,
stood at 39.9 in 1941-51, declining to 21.4 in 2013.
The Crude Death Rate declined from 27.4 in 1941-51 to
7.0 in 2013.
India’s achievements in health care have not been
comparable to its economic gains and it has worse health
indices than most developing countries in the world.
19. Life expectancy, which was around 30 at the time
of independence, is now in the mid-sixties.
20.
21. THE CONSTRAINT CONTINUES.
In spite of the stated objective of raising the outlays
for public health from 0.9 % to 3 % of GDP by 2012
through NRHM and expanding public health
infrastructure substantially, the public health
spending remains just above 1 % of GDP
This resulted in continuing poor quality of
preventative care and poor health status of the
population and forced people to seek private care,
22. THE PLAGUED INDIAN HEALTH
SYSTEM
Indian health system is plagued with serious problems
such as sharp inequalities in health outcomes,
deficient coverage, unequal access, poor quality and
high costs.
These serious deficiencies are not accidental. They
have been primarily caused by the patterns of
financing for healthcare in India.
Per capita public health spending is an extremely
significant variable affecting life expectancy at birth
23. DEOLIKAR ET AL (2008)
Deolikar et al (2008) observed that public spending
on health in India peaked at about 1.6 % of GDP and 4
% of the government budget in the mid 1980s.
During the 1990s, government health spending
failed to keep up with the expanding economy, and,
by 2001, it constituted 0.9 % of GDP and 2.7 % of the
government budget.
These numbers fell to 0.8% and 2.4%, respectively, by
2005.
24. SRS 2013.
Given that there are schemes across the country that
offer incentives deliveries in private sector facilities, this
is a remarkable result.
However, the revised health sector plan expenditure is
25.
26. THE ROLE OF THE PRIVATE SECTOR
IN HEALTH CARE DELIVERY
There is vast diversity in the composition of the private
sector, consisting largely of sole practitioners or small
nursing homes having 1-20 beds; serving the urban
and semi-urban population and focused on curative
care
27. In the absence of regulations governing location,
standards, pricing, to name a few, private facilities run
in marketplaces, residential colonies, pharmacy shops,
with freedom to provide any kind of service, of
whatever quality and at exorbitant cost, which varies
from facility to facility.
Of concern is the documentation, though limited, on
the poor quality of services being provided at the rural
28. ISSUES FOR POLICY
EQUITY: COST OF CARE
Pricing of services in the private sector is influenced
by the source of capital and interest rates and prices
of other inputs such as labour, rentals, technology,
etc.
QUALITY OF CARE
Whether people are getting value for their money is
difficult to evaluate in the absence of norms or
yardsticks with which to measure good quality
against bad.
While the private sector has expanded access and
29. PUBLIC POLICY RESPONSE:
PUBLIC-PRIVATE PARTNERSHIP
Having realized the
dominant position of the
private sector, the
government has, of late,
attempted to engage the
private sector in
providing services under
the national health
programmes with the
30. HUMAN RESOURCES FOR HEALTH
• The first contact for care in the organized health
system: THE MULTIPURPOSE HEALTH WORKERS
• NURSING SERVICES: shortage of nurses
• The nurse to population ratio in India is 1:1264
while in Europe it is 1:100-200
• AVAILABILITY OF DOCTORS
31.
32. INITIATIVE BY GOI
AT NATIONAL LEVEL
NRHM
RSBY
AT STATE LEVEL
STATE HEALTH INSURANCE
8/5/2016 32
33. NRHM
• Launched in 2005 – to provide universal access to
equitable, affordable and accountable quality health care
• Better staffing as per IPHS and HR developmental policy.
• Rogi kalyan samiti
• 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.
8/5/2016 33
34. 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:
• 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
8/5/2016 34
35. 12TH PLAN INITIATIVE
• Universal health coverage
• Private sector has to be partnered for health care
delivery.
• Essential medicine list needs to be brought under
price control mechanism,
• Incentivization of states
• Flexibility in central funding for state
8/5/2016 35
36. OTHER MODELS OF
FINANCING
• PUBLIC PRIVATE PARTNERSHIP (PPP)
• MEDICAL TOURISM
• FDI IN HEALTH SECTOR
• RESOURCE GENERATION BY FACILITIES AND
COLLEGES
8/5/2016 36
37. 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.8/5/2016 37
38. CHALLENGES
• Insurance covers only the cost of hospitalization and
not expenditure on outpatient care. Statistics show
that close to 70% 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
8/5/2016 38
39. RECOMMENDATIONS
• Rather than further expand the provision of free
primary, secondary, and tertiary health care services in
the public sector, the government must focus on
providing financial resources to the poor for routine
and non-routine care.
• Once the poor have been provided the financial
resources necessary to pay for their health care
expenditures, there does not remain a case for
40. The assumption seems to be that community
empowerment and participation will happen with
minimal effort or financial commitments.
Focused and adequate financial commitments
for community based accountability measures
and decentralised planning will be a step forward
in the right direction.
41. REFERENCES:
• Report of the national commission on
macroeconomics and health 2005
• Financing and delivery of health care services in India:
background papers of the national commission on
macroeconomics and health.
• Health care financing reforms in India: M. Govinda rao
and Mita Choudhury
• Government health financing in India: challenges in
achieving ambitious goals: Peter Berman, Rajeev
Ahuja, Ajay Tandon, Susan Sparkes and Pablo Cottret
• Financing healthcare for all in India: towards a