Healthcare Reforms in India
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The paper was presented at the NetHealth Workshop 2017.
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Healthcare Reforms in India
- 1. Healthcare Reforms in India NetHealth Workshop 2017 Sharanya Rajan Mithileysh Sathiyanarayanan
- 2. Workshop Questions 1) How can healthcare be made affordable in India? 2) What measures can be taken to make healthcare accessible in India? 3) Why you think we need technology in the healthcare sector? 4) What are the other factors affecting quality of healthcare in India? 5) What do you think about the great discrepancy in the quality and coverage of medical treatment in India?
- 3. Ten-points to improve the healthcare system in India
- 4. Affordability Reasonable cost of the medical services for the economically weak people. Free health camp should be promoted by government and public hospitals.
- 5. Accessibility Healthcare centres should be situated in central place where there is good transport services. Patient friendly mobile applications which enables instant contact with the doctor should be encouraged. Access to technological devices, applications and medical information should be promoted by the Government .
- 6. Availability Healthcare centres should possess well equipped medical facilities. Most importantly availability of multi- speciality doctors 24x7 should be ensured by the government.
- 7. Acceptability Patient’s acceptability is an essential tool to promote good health. Patient’s acceptability can be accentuated by good inter personal skills of the doctor. The physicians should make the patient understand the importance of health based technological advancement.
- 8. Prioritization of patients based on the nature of health issues Accidents and Emergencies should be given first priority followed by geriatrics and paediatric age groups. Patients, whose is not critically ill, in the Outpatient Department (OPD) or get treated in day care. By following such system strictly we will be able to meet the health needs of all.
- 9. Doctor-Patient ratio India has just 1 doctor for every 1,681 persons Efforts have to me made jointly by the government and private sector to improve the doctor to patient ratio. Reservation for medical seats should be removed, medical seats should be available at reasonable cost
- 10. Work Force/Human Resource The human resource techniques to employ people should be improved to increase the employees in the medical fields . Better wages, awards, promotion and a standardized yearly salary hike should be promoted by all government and private hospitals, medical colleges .
- 11. Public-Private Partnership Over the recent decade, there has been an increased affinity in growth of interest in public-private partnership (PPP) for health in India. PPPs are a form of long-term contract between a government and a private entity, through which the government and private party jointly finance public services. The awareness about PPPs much be encouraged through medical education in various institutions, conferences related to PPPs should be conducted yearly.
- 12. Health Insurance/Social healthcare Enormous efforts have been made to enhance the reach of healthcare in India. The out of pocket expenditure on healthcare is about 85.9% (World Bank). Health insurance in India can be improved: • Equal importance has to be given to cover primary and secondary healthcare needs under insurance schemes. • To deliver the insurance schemes more effectively, it should be backed up by technology so that the citizens have an easy access to the health schemes. • All Insurance companies should cover pre existing diseases. • The waiting period for approval of insurance should be minimum and should not cause inconvenience to the patients.
- 13. Quality The quality of medical care in India is on a decline due to shortage of medical professionals, poor infrastructure, poor information technology, poor quality medical research and survey. The quality can be improved by: • Focus on increasing the number of doctors and paramedics • Improvisation of infrastructure in hospitals • Improvisation of healthcare information technology • Quality research and surveys
- 14. Thank You
Editor's Notes
- Free camps must be organised regularly to meet the health needs of people. Free medications must be provided for children and elderly people by the
- Healthcare centres should be situated in centre of a city/town/village where there are good transportation facilities, thereby enhancing easy access to medical services for the people
- Patient’s acceptability can be accentuated by good inter personal skills of the doctor in helping the patient understand health problems, and need for treatment. Medical technology is a vast field where innovations play an important role in sustaining healthcare sectors. Fields like biotechnology, pharmaceuticals, information technology and other allied fields have helped in the development of medical devices and equipment, and more have all made major contributions to improving the health of people all around the world. From “small” innovations like adhesive bandages and ankle braces, to larger, more complex technologies like MRI machines, artificial organs, and robotic prosthetic limbs, technology has undoubtedly made an incredible impact on medicine
- Accidents and Emergencies should be given first priority followed by geriatrics and paediatric age groups. If this system is followed emphatically, hospitalization of such patients will be a easier process as there will be ample number of beds available for hospitalization and thereby providing better healthcare to patients in critical state. We are very emphatic about this as we have been a part of the hospital set up in India. We have seen many instances where people with a minute health problem gets hospitalized where actually hospitalization is not required, this causes a chain reaction where the critically ill patients run short of hospital beds, causing the patient and the patient’s attender agony in such situations. In order to avoid such mishaps, prioritization of patients is essential
- India has just 1 doctor for every 1,681 persons (Source: MCI), which is much lesser than the WHO prescribed limit of 1 doctor:1000 population. This depicts an extremely poor ratio, which is having an alarming effect on the medical field. Last point – and healthcare in rural areas should be encouraged
- The recent trend in medical field is that there is a lot of outflow of people from India to other countries due to better wages and other facilities. This has drastically plunged the number of nurses, lab technicians and paramedics in our country. To prevent further efflux, the human resource departments should be more innovative and constructive in their techniques of outsourcing employees. Better wages, awards, promotion and a proper yearly salary hike should be promoted by all government and private hospitals, medical colleges . This will create a good environment for employees and improve their efficacy at work.
- PPPs are a form of long-term contract between a government and a private entity, through which the government and private party jointly finance public services. Through this partnership, the private sector takes on a large responsibility of financial, technical and operational risks and is held accountable for desired outcomes. PPPs approach can be implemented practically in wide range of healthcare systems. For example, construction of facilities, provision of medical equipments or delivery of healthcare services across the continuum of care. The Rashtriya Swasthya Bima Yojana (RSBY) is a national health insurance scheme funded by government of India targeting the below poverty line population. It was launched on April 1st 2008 - In this scheme, people can get free inpatient services from both government and private hospitals. Below Poverty Line (BPL) people have to pay only Rs 30 to register and get enrolled in this scheme. The government pays the premium for the BPL population. The government covers health expenditure of INR 30,000 per year and also the transportation charges incurred upon. The government has also made private hospitals services accessible to the poor by linking many private healthcare centres under this scheme. The government finances the expenditure of the poor inpatients and the private or government hospital will provide medical services. This is a really good innovation in field of public private partnership by the government of India. . One example of public private partnership in India is the establishment of the Shillong Medical College, with the help of the private sector. The International Financial Corporation (IFC) provided financial help to the government of Shillong in developing the Shillong medical hospital into a medical college come hospital. This plan was been approved in 2012. The Shillong Medical College and hospital will start functioning from 2017. The main aim in starting this medical college is to provide affordable and accessible healthcare facilities to the people of Shillong, also to produce more qualified doctors from Shillong as they will be able to be a part of the healthcare system in Shillong. This is the first PPPs in India in medical sector. This will set a benchmark on how public private partnership can be beneficial to the public and in developing the nation. The awareness about PPPs much be encouraged through medical education in various institutions ( government and private), conferences related to PPPs should be conducted yearly. Through this people will understand the importance of PPPs and come up with innovations in this regard.
- Health insurance in India can be divided into 3 divisions: 1) commercial insurance (health covers, maternity covers, accidental covers, etc.). 2) government welfare schemes which are completely funded by the government where the beneficiary does not have to pay to avail the benefits of the scheme (Tamilnadu Chief Minister’s health insurance scheme). 3) health schemes which are part insurance and part welfare where the beneficiary has to pay some nominal premium to avail the benefits (Rashtriya Swasthya Bima Yojana) Health insurances covers only tertiary care i.e , if the patient gets hospitalized and should be hospitalized for 24 hour period 2. Health insurance does not cover primary and secondary healthcare i.e OPD visits, diagnostic tests, pharmacies. 3. Many insurance companies do not cover pre existing diseases 4. Many insurance companies do not cover certain diseases and certain medical procedures 5. The waiting period is too long for an insurance to get approved once the patient is planned for discharged from the hospital. Many insurance companies do not cover certain diseases and certain medical procedures 5. The waiting period is too long for an insurance to get approved once the patient is planned for discharged from the hospital. Problems with health insurances in India Health insurances covers only inpatients care. Health insurance does not cover OPD visits, diagnostic tests, pharmacies. Many insurance companies do not cover pre existing diseases. Many insurance companies do not cover certain diseases and certain medical procedures 1. Equal importance has to be given to cover primary and secondary healthcare needs under insurance schemes, be it private or government schemes as it will reduce the expenditure on healthcare considerably especially ,the below poverty line family. 2 . To deliver the insurance schemes more effectively, it should be backed up by technology so that the citizens have an easy access to the health schemes . This enables better coverage and knowledge of the health schemes among the citizens. 3. Insurance companies should cover pre existing diseases. 4. The waiting period for approval of insurance should be minimum and should not cause inconvenience to the patients.
- : To enhance the number of qualified medical doctor and paramedics should begin at grass-root level i.e to increase the number of the seats in the medical college, to set up more medical colleges and hospitals in rural areas, thereby giving a chance to the locals to study and at the same time increasing their employability status. Also, there are long waiting times in the hospitals and doctors/physicians don’t take time in explaining medical related issues in detail. All this will indeed help in improving the doctor to patient ratio and help in enhancing better quality of healthcare towards patients. Most rural hospitals, lack good infrastructure. This is due to poor funding by the government. Government should allocate a good amount of funds towards the development of healthcare infrastructure. This will provide better patient satisfaction and improve the quality of medical care. The patients living in rural areas need not travel to hospitals in towns / cities for medical care thereby reducing their out of pocket expenditure. : Information technology in healthcare needs a lot of growth in India. With the help of HIT, access and coverage of health services will reach a peak. Focus on HIT should be brought into limelight by the health makers with support from the government. A lot of quality research and surveys are needed in the medical field. Most surveys these days in India do not give accurate details about a disease(Source: WHO) and cannot be relied upon. The quality of surveys and research has should improve considerably. Measures should be taken to conduct surveys and research in the right manner to come with good databases and innovations in medical field. All these aid in building the healthcare industry to a global level.