CHAIRMAN – TAG-VHS Diabetes Research Centre, Voluntary Health Services, Chennai, INDIA. EDITOR – INDIAN SUB–CONTINENT – THE JOURNAL OF THE SCIENCE OF HEALING OUTCOMES.

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Dr. C.V.Krishnaswami - FRCP(E)., F.A.M.S., D.T.M & H(EDIN)

NANO HEALTHCARE ENSURANCE CONCEPT &

A FLEXI – MODEL FOR INCLUSIVE SELF SUSTAINING

HEALTHCARE for 120 Billion Plus Population of INDIA

February 5th 2015

by

The Real issues affecting the Health of Elder Citizens (Part I) &Presenting The Nano Health Ensurance Concept (Health Security for All) (Part II)

Bharatiya Vidya Bhavan, Chennai Kendra Golden Jubilee Medical Lecture Series – 3. September 21, 2008

IT Enabled Nano Health Ensurance Model for providing FreeAthens Greece Nano Health Concept – 27th February – 1st March 2009

The 98th South India Heritage Lecture Series Healthcare and Senior CitizensThe Real Issues Affecting the Health of Elder Citizens – Part – I

Presenting The Nano Health Ensurance Concept (Health Security for All) – Part II On 25th April 2010.

MEDICAL EDUCATION AND RESEARCH In Independent India A Critical Review (Lecture 2)I.I.T - M – 14th August 2010

MEDICAL EDUCATION AND RESEARCH IN INDIA SHOULD BE AIMED AT IMPROVING INCLUSIVEHEALTH EXPECTANCY OF THE BILLION PLUS PEOPLE ARE WE GOING IN THE RIGHT DIRECTION?

On 12th Feb 2011.

NANO HEALTH ENSURANCE CONCEPT & MODEL FOR INCLUSIVE, SUSTAINABLEHEALTHCARE for 1 Billion Plus Population @ 2nd Annual Healthcare Expansion

Summit India (Taj Exotica, Goa, India.) on June 2nd-3rd 2011

MEDICAL EDUCATION AND RESEARCH IN INDIA SHOULD BE AIMED AT IMPROVING INCLUSIVE HEALTH EXPECTANCY OF THE BILLION PLUS PEOPLE ARE WE GOING IN THE RIGHT DIRECTION? 03-03-2014

Implementation of Health as a Fundamental Right in Tamil Nadu (State) & India (Country)

“Presenting the Concept of Nano Health Ensurance Model”

Presented at the National Seminar

“Health is the Basic Right Challenges to Humanity: Current Strategies of Public Health & Medicine”

Organised by University of Madras, Department of Anthropology and Tamilnadu Health Development Association, at Chennai On 16-04-2010

Preamble

Health for All by 2000 AD

World Health Organisation Meeting.

Alma Ata – Held at Kazakhstan in the year 1978

Hype, Noise & Huge Failure.

Money Wasted – Several Millions $$$$$$

Does Any Government even remember the programme,Details & its Implementation – Leave alone Talk about it,One Decade after the Deadline!!!!!!!!!.

What is Health?

There are thousands of ways for the body and mind to go wrong, which iswhy disease is so interesting. We’ve put huge energy into classifying disease,and even psychiatrists have identified over 4000 ways in which our mindsmay malfunction. Health for doctors is a negative state – the absence ofdisease. In fact, health is an illusion. If you let doctors get to work with theirgenetic analysis, blood tests, and advanced imaging techniques, theneverybody will be found to be defective – “dis-eased.”

Richard Smith

1. Tinetti ME, Fried T. The end of the disease era. Am J Med 2004; 116: 179-85.

Pursuing health and fleeing disease

But what is health? For most doctors that’s an uninteresting question. Doctors are interested in disease not health. Medical text books are a massive catalogue of diseases.

What is Health?

Mary Tinetti and Terri Fried have argued in the American Journal ofMedicine that thinking in terms of disease has become counterproductive.“The time has come,” they write”to abandon disease as the focus ofmedical care. The changed spectrum of health, the complex interplay ofbiological and non-biological factors, the aging population, and the interindividual variability in health priorities render medical care that is centeredon the diagnosis and treatment of individual diseases at best out of dateand at worst harmful. A primary focus on disease may inadvertently lead tounder treatment, over treatment, or mistreatment.”

Consider a patient called Lucy. She has heart failure, diabetes, asthma, andosteoarthritis. Her cardiologist treats her heart failure, her diabetologist herdiabetes, her diabetes, her chest physician her asthma, and herrheumatologist her osteoarthritis. Her general practitioner holds the ringand writes her prescriptions. But actually she’s not much interest in herdiseases, and she’s not worried about dying. Indeed, if she could get to seeher son in Australia one more time she’d welcome death: life has neverbeen the same since her husband died. She needs a travel agent, not fivedoctors, but doctors are supplied on the NHS and travel agents aren’t.

Richard Smith

Pursuing health and fleeing disease

1. Tinetti ME, Fried T. The end of the disease era. Am J Med 2004; 116: 179-85.

The Hindu – Monday, April 12th 2010

Dr.Samir K.Brahmachari, Scientist and Director-General of the Councis of Scientific and IndustrialResearch (CSIR) said “ We need to have a balanced view between health as a right and health asa business. It is because there has been imbalance in this view that diseases like TB, with highmortality but low profitability, are neglected by the current system of pharmaceutical research”.

“ As virtually no new TB drugs have been developed since the 1960s, the OSDD’s model inparticular holds great promise for the scientific community by stimulating the development ofbetter drugs and diagnostics for patients” he said.

“ With children and people living with HIV in India and other developing countries bearing thegreatest burden of the disease, as well as the emergence and spread of TB that was resistant totreatment by the standard anti-TB drugs, there was an urgent global, but unanswered, need fornew drugs.

Loon Gangte of the Delhi Network of Positive People, a support group for people living withHIV/AIDS, said “TB research has yet to see any great progress as we struggle to pull ourselvesout of a system that places profits before people’s lives. India’s OSDD project holds immensehope for my community”.

“For us, the irony is that with the availability of drugs for HIV and particularly of safe andaffordable Indian generics, we are living with HIV but dying of TB”

The Hindu – Monday, April 12th 2010

The HINDU, Friday, Dec 26, 2014, page 1.

Health as a fundamental right is the cry as the GOI releases its NationalHealth Policy the report in ‘The Hindu’ of January ‘2015, states that thirteenyears after the previous Health Policy, the drafted, now in public domain forstake holders’ suggestions and commends, has addressed the issues ofuniversal health coverage, reducing maternal mortality and infant mortality,access to free drugs and diagnostics and changes in laws to make themmore relevant. In the same paper elsewhere, the reporter Smriti kakRamachandran states the government cuts health budget target to 2.5% ofGDP, though the accepted understanding that a full achievement of themillennium development goals will require an increase in public healthexpenditure from 4 to 5% of the GDP.

Introduction

The Nano Health Ensurance was conceived because of a direly felt need for aworld class health insurance facility/model that would be inclusive of alleconomic sections of any society globally, as well as, exclusively catering tothe special needs of the premium groups of the premium payers; in short thisconcept is a versatile solution resulting from the amalgamation of all thevalidated, salient features of 3 outstanding experiences in the fields ofCommunity Health Care dispensation and community economic uplift – inIndia, U.S.A. & Bangladesh.

This model projects PREVENTIVE, PROMOTIVE as well as CURATIVE aspects of Health careand has as its goal, the lessening of the tertiary care burden. It also has a national plan foroutreach primary care centres with a central facility to train the personnel (Hand pickedfrom the locality, where the PHC is situated) and mould them into multipurpose communityhealth workers on the lines of what was much later labeled as ANGANWADI HEALTHWORKERS.

These community health nurses were trained comprehensively in preventive health careactivism, in areas like environment, hygiene, vaccination surveillance and implementation,proper and balanced nutrition, particularly for children and expectant mothers in thecommunity. They also take care of emergencies and give first aid, CPR and can train a teamlocally to form a local primary self help group before transporting to the nearest highermedical facility/Hospital.

1. The Voluntary Health Services Model (Chennai,India) which grades its beneficiaries into 4economic groups and has a premium of a small0.5 % of the annual income of its beneficiaries.

Dr.K.S.Sanjivi’s

VHS MODEL

The Voluntary Health Services has completed 50years of service in the Non GovernmentalOrganisation (NGO) sector successfully and isboth nationally and internationally, known for itsexpertise and integrity in dispensing its goals.

Thus the USAID had recognized Voluntary HealthServices as the nodal centre in India for spreadingits AIDS awareness programme throughout southIndia for its AIDS prevention programme andentrusted several million $ for this purpose;which was successfully achieved. This has beenfollowed by the Bill Gates foundation which ispresently routing a very large donation forhelping to treat HIV/AIDS victims as well as forpreventive efforts, in this vitally important PublicHealth problem.

This aspect of instant availability of personal Health Records drastically reduces the dangersof Adverse Drug Reactions (ADR) and medical errors which together accounted for more than200,000 documented deaths in 2007 (vide - Death by Medicine by Gary Null ).

Thus it can be seen clearly that the success of real health care provider-model should lie inan IT based model that has a comprehensive and validated Online Interactive ElectronicPatient Health Record System.

2. The KAISER PERMANENTE MODEL – A Californian non-profitorganization, whose health care delivery model has been studied andadmired way back in 2002 by The British Medical Journal whocompared it with the National Health Service model of the UK andstated that the Kaiser Permanente model was superior to the NationalHealth Service primarily because of the increased use of theInformation technology by the former and it’s online personal HealthRecords that can be accessed by its doctors and nurses in emergenciesand other situations, so that the quality of treatment improvedconsiderably because of the background information available at theclick of the mouse. (My illness, my Record by Tessa Richards BMJ/10March 2007/Vol 334) Page 516.)

The Nano Health Ensurance concept takes inspiration from all the above 3 efforts intransforming the society’s aspirations into reality by proposing a Health Ensurance conceptthat would tap as premium 1% of the annual income of the higher economic groups (4)giving them premium care in terms creature of comforts and facilities they expect in theirhealth care needs, while including GRATIS the 2 other groups viz. the Subsidized group andsmallest economic group – Nano group – with each premium group registration.

3. GRAMEEN BANK MODEL: Lastly the most successfuland inclusive model in the banking sector whichcaptured world-wide attention for economicupliftment of the community in the III worldCountry, Bangladesh and won the Nobel Prize forthe year 2006 was the GRAMEEN BANK MODEL ofDr. Mohammed Younus which transformed thepoorest of the poor in Bangladesh into self-sustaining and growth oriented units. The famousmanagement Guru & Icon C.K. Prahlad called thisthe ‘Bottom of the pyramid’ model.

The medical facilities and serviceshowever will be the same for all the 3groups under one roof (The multispecialty e-hospital)

In popular parlance the Nano HealthEnsurance concept could be compared toan international jetliner which takes thepremium First class, the business class,the economy plus and the economy classall in the same plane to the samedestination successfully.

Health Security Economics

The American Healthcare Model is a failure by their own Admission

5th July 2008 30th March 2013

The National Health Service (NHS) Model (U.K.) -- 60 years on

Positive Aspects Negative Aspects

National Health as the goal wide gap in personalized vs NP care. LessAffluent Economics cannot afford this £105 BNper year. Government spends (Average £3500 forevery + working………..

All Diseases/ailments are covered Health needsincluding deliveries and Women's & Children's.Welfare covered (Dental/Nursing Care recentincluding after 60 years)

Unisystem (Modern Medicine only) Many greyareas in medicine and chronic insurable ailmentsare not given any other option. Maternityservices not customized.

All age groups are covered

Several Regional Trusts take care of specialrequirements of these regions.

Long wait-list for even simple surgical conditionslike Hernia, Cataracts, etc… Laser PC even forvision threatening stage may sometimes have towait for long periods.

Truly egalitarian in creature-comfort terms (LIG,MIG, HIG all have same level)

For those who can afford and who pay more andare used to Deluxe comfort levels the service is alet down.

Academic Institutions give the advantage ofhigher quality of scientific expertise.

Academics investigations can sometimes becounter productive (UCH eg).

An Outdated Model

The NHS was nothing but a “politically controlled state monopoly that isinefficient, outdated, and unsustainable,” he said, claiming the UK taxpayerdoes not see an adequate return on its almost £105n (€133bn; $209bn) annualinvestment – an average of £3500 for every working Briton. “Yet we have someof the worst survival rates in Europe for cancer and strokes. Spending on theNHS under this government has more than doubled in less than seven years.Where on earth does all the money go? Are we twice as healthy?”

The Indian Scenario

GENERALLY SPEAKING PRESENTLY WE HAVE DISEASE INSURANCE SCHEMES (Not Health Insurance Schemes)

Encourages Deceit/Mistrust Falsehood Aggression LITIGATION Unethical-Medical & Practices Trade etc..

Premium and Limit oriented Diseases oriented ORGAN oriented Questions oriented Rejection oriented Profit Oriented

Trust

Transparency

Truth

Total Health

Oriented

Nano Health Ensurance is a revolutionary, completely transparent & inclusive Health ensuring model where the affordable persons pay 1% of their total income and this automatically covers the Health Ensurance of 1 – 2 persons of their choice like for 1year

Close relatives (Parents, Siblings)(and)

Dependants and Domestic Helpers (Children’s Nannies & Drivers, etc…)

This concept is

Premium Groups

A B C D

Subsidised Groups (E)

(SG)

(FREE)

(NANO GROUP) (F)

The Premium amount (perday)envisaged is 1% of their DailyIncome. (For groups (A) to (F)National premium for costs ofgroups (E) & (F) will beabsorbed by the premium paidby groups (A) – (D))

(FREE)

(NG)

(Works out to > 2% of income)

A simple Mathematical Calculation

India has over 70% of its population (1billion) earning LESS THAN Rs.40 per day(BPL Persons) (GoI Report)

If these BPL people are made to payRs.1 per day it constitutes >2% of their income.

From the Total Annual BudgetAllocation of the country, GoI spendsaround 5% for Health (All aspectsincluded) Is it fair to ask a BPL person tospend 2.5% of his annual income for alimited Health cover?

By the Central Govt (GOI) PPPBy the State Govt. (Tamil Nadu) PPP

Chief Minister’s Health Insurance Scheme for Life threatening disease

Health Insurance Schemes For the Public

Dr.Reddy further questioned the viabilityof public-private partnership projects in

the infrastructure space saying "weneed proper institutionalmechanism to support acorporate bond market. Unlesswe put in place properinstitutional and governancemechanisms, public-privatepartnerships in the infrastructurearea can well become privateprofit at the cost of publicexpenses," - PTI

Death by Medicineby Gary Null, PhD, Caarolyn Dean, MD, ND Martin Feldman, MD, Debora Rasio, MD, Dorothy Smith, PhD

Ref . http://www.encognitive.com/files/Part%20I--Death%20by%20Medicine.pdf - 2007

Rosuvastatin: Risky in Indians (FDA RED ALERT)Western drug regulators have made it obligatory that prescribers inform all patients that rosuvastatin can cause muscle injury which insevere cases “Can cause kidney damage and other organ failure that are potentially life-threatening.” Hence patients should“promptly report signs and symptoms of muscle pain and weakness, malaise, fever, dark urine, nausea or vomiting” to their doctors.

“OVER MEDICATING SENIORS”

Aspirin Increases Stroke Risk (FDA RED ALERT)

The use of low dose aspirin – a day not only does not reduce but actually increases the risk of heamorrhagic stroke by a whooping 69per cent in males.

There is no beneficial effect on the risk of ischaemic stroke.

These are the results of a meta – analysis of 95,000 patients enrolled in six randmonised controlled clinical trials. (Ref. AM, HeartAssociation)

MIMS May 2007

Condition Deaths Cost Author

Adverse Drug Reactions 106,000 $12 billion Lazarou1 Suh49

Medical error 98,000 $2 billion IOM6

Bedsores 115,000 $55 billion Xakellis7 Barczak8

Infection 88,000 $5 billion Weinstein9 MMWR10

Malnutrition 108,800 -------- Nurses Coalition11

Outpatients 199,000 $77 billion Starfield12 Weingart112

Unnecessary Procedures 37,136 $122 billion HCUP3,13

Surgery-Related 32,000 $9 billion AHRQ85

TOTAL: 783,936 $282 billion

Death by Medicine by Gary Null, PhD, Carolyn Dean, MD, ND Martin Feldman, MD, Debora Rasio, MD,

Dorothy Smith, PhD

ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTION [Value of EMR in Reducing this]

Less is moreProfessor BM Hegde,hegdebm@gmail.com

The study was a 30-day mortality rate for 8,570 Medicare beneficiaries who werehospitalized for acute heart attack, heart failure or cardiac arrest on national cardiologymeeting dates from 2002 to 2011. The editor wrote that "One possibility is that moreinterventions in high-risk patients with heart failure and cardiac arrest lead to highmortality." She must be right I feel. The rates were then compared to 57,471 similarpatients who were admitted three weeks before and after meeting dates. (Anupam B.Jena, Vinay Prasad, Dana P. Goldman, John Romley. Mortality and Treatment PatternsAmong Patients Hospitalized With Acute Cardiovascular Conditions During Dates ofNational Cardiology Meetings. JAMA Internal Medicine, 2014; DOI:10.1001/jamainternmed.2014.6781)

Ref – http://www.pubmedinfo.com/lessmore.aspx

Salary / Day`

Salary / Month`

Premium/Day`

% ofIncome

Categories

100 & less 3000 1 1% Free/ Nano Group (F) (NG)

500 15000 5 1% Free/Nano SubsidisedGroup (E) (SG)

1000 30000 10 1% Premium'D'

3000 90000 30 1% Premium'C'

6000 180000 60 1% Premium 'B'

10000 300000 100 1% Premium 'A'

Envisaged Premium Categories and the Economics of the Nano Health Ensurance Plan

All Values in Indian Rupees (INR)

Note: If 100,000 Persons are enrolled in each Category the Total Premium will be ` 741.6 Crores / annum.

For groups (F) Free or Nano Group & (E) Nano Subsidised Group the total Annual Premium for 100,000

Persons each amounting to ` 21.6 Crores can easily be waived & absorbed by groups A to D.

The premium paid by 4,00,000 persons (Group A – D) will be ` 720 Crores can provide full health cover for the other 2,00,000 persons free of cost.

WHAT ARE THE HIGHLIGHTS OF NANO HEALTH ENSURANCE MODEL?

a) Once you are registered there are no more tedious forms to be filled or permission required;No questions are asked about past, present or future illnesses or diseases. Once registered, allhealth problems are automatically covered fully. You are treated as a dignified and respectedpartner in our Health Care Services Venture. Your positive feed-backs and inputs will be sought tobe implemented by the organization to better the Quality of service Quotient.

b) Unnecessary medical or surgical or other interventions (which cause more harmthan good) are scrupulously avoided and with this same money that is being spent presently bythe system (governmental and non-governmental healthcare agencies). This model can servedouble the number of beneficiaries with very much superior outcomes (Health indices)

c) This model is self-sustainable model without any external economic burden to the government aswell as the society. Far superior to the national health service NHS model of the U.K which waswholly dependant on the government which collected premium from all working people of allages and all walks of life.

d) You get an exclusive, unique and secured on-line EMR which could be retrieved anywhere in the world, anytime you are faced with medical problem or emergency toassist your doctors (a very important life-saving medical tool) not available in mostinsurance systems in the world.

WHERE WILL THE NHE BE AVAILABLE?

TAG VHS Diabetes Research CentreChennai, Tamil Nadu, India.

We envisage to implement this Nano HealthEnsurance model in a limited manner for about1000 persons at TAG – VHS Diabetes ResearchCentre to show its efficacy, practicability,viability & superiority in terms of Health,Wellness & Disease & Treatment outcomes.

Pioneering research is to be undertaken by the Voluntary Health Services DiabetesDepartment at The TAG – VHS Diabetes Research Centre, during the past 4 years in the fieldof energy medicine.

a) Pulsed Electromagnetic Field energy therapy (Prof. B.M. Hegde)b) EDTA Chelation Therapy;c) Dynamic Acupuncture Mediated Meta Physical (DAMM) Therapy (Rajan Iyer)d) Collaboration with Ayurveda, Homeopathy, Yoga and Wellness concept championed byProf. B.M. Hegde.

and

WHERE WILL THE NHE BE AVAILABLE?

All these go into the successful, Patient - centered outcomes, with full sceintificdocumentation done at our centre and available on-line for anyone to view, learn,understand and for critical discussion at (www.tagvhsdrc.com)

We are planning to introduce shortly a new scientific study called “PAIDA LAJIN”technique of universal self – healing, introduced by the Chinese healer Hongchi Xiaowww.paidalajin.com.

MERITS OF Nano Health Ensurance Model

a. This is an all inclusive Insurance concept, it envisages health as a societalcommitment and is inclusive of all economic levels and illness and healingoutcomes as a holistic model combining the modern science with Ancientwisdom. It also fosters the concept of family bondage, brotherhood of peopleand welfare in society (Governmental or Corporate Social Responsibility).

b. Improves quality of medical care (EMR) and trust between medical profession,patients and healthcare provider.

c. Reduces the risk of ADR – which accounts for several lakhs in treatmentmorbidity and related mortality every year.

d. Gives patients several authenticated health care options and should be welcomed byall modalities of healthcare systems.

e. This is a more authentic medical statistical model then the existing medical scienceand will provide vital inputs when applied at the National level.

f. No Administrative hassles (Filling forms, answering queries etc).

g. Complete medicare coverage with virtually no exclusion criteria (exceptingCosmetology or non medical interventions like Botox etc.)

MERITS OF Nano Health Ensurance Model

RELATIVE LIMITATIONS:

a. Extensive use of I.T. – Infrastructure needed.

b. Training of all the participants in this venture (doctors, Insured persons,administrative staff, etc.).

c. Certain contagious diseases like cholera, Pox, HIV/AIDS etc. will be excludedfrom/cover by NHI. But-customized packages could be worked out for specialsituations and cases.

d. Certain highly specialized medical/surgical modalities (eg. Stem-celltherapy/complex cardiac surgeries etc) would be out-sourced to affiliated andaccredited institutions only if recommended by our panel of experts, whenthe charges will be borne by the N.H.E.

e. For NHI concept to become a national success it needs the backing of allparticipants who should co-operate in improving their own health and also

enabling in giving HEALTH CARE FOR their kith and kin.

Thank You Allwww.tagvhsdrc.com

www.pubmedinfo.com