• Reduction in IMR and MMR

• Universal access to essentials like women and child health, water, sanitation, immunisation

• Prevention and control of communicable and non-communicable diseases

• Integrated primary care

• Population stabilisation incl gender balance

• Revitalise local health traditions

• Health promotion

National Rural Health MissionNational Rural Health Mission

ample evidence of a dysfunctional, non-performing public health system. …The situation varies across the country and in some parts of the country it functions very well. I think on an average, it does not function well and there are some parts where it is really functioning incredibly badly

Montek Singh Ahluwalia

Dy Chairman, Planning Commission

• Established in 1981 in Mumbai

• Now, a leader in Indian Referral Laboratory Market, processing over 5 million samples per year and its 25th year of existence

• The fastest growing pathology chain in India with 10 state of the art clinical laboratories across the country

• The only Indian pathology chain with a direct international presence in Dubai- UAE, Mahe -Seychelles, Colombo – Sri Lanka, Bahrain

• Presence in 125 towns and cities with more than 250 collections centers across the country catering to more than 3000 laboratories, hospitals, nursing homes and more than 10,000 consultants all across India.

• Exclusive alliance with two 1500 bedded hospitals for conducting Clinical Trails and Research - Sri Ramachandra Medical College and Research Institute (Deemed University) Chennai and M.S. Ramaiah Medical College and Research Institute (A joint venture for SMO)

1983First super-specialty corporate hospital in IndiaApollo Hospitals, Chennai

Started with 150 Beds; today

has 700+ beds

SMALL STEP TOWARDS A BIG SMALL STEP TOWARDS A BIG REVOLUTIONREVOLUTION

20 Owned hospitals, 20 Associate hospitals and over 30 clinicsOver 6800 beds, 14 Cardiac Institutes, 6 Oncology Institutes

Medical Tourism to IndiaMedical Tourism to India• Currently worth $333 million, additional revenue

of $2.2 billion expected by 2012• c150,000 “medical tourists” in 2003• Potential to attract 1 million tourists per annum -

US$ 5 billion • A Heart Surgery in the US costs US$ 30,000

while it costs US$ 6,000. Bone marrow transplant in the US costs US$ 2, 50,000 while it is US$ 26,000 in India, CII points out

• India is unique as it offers holistic medicinal services, with yoga, meditation, ayurveda, allopathy, and other systems of medicines

National Workshop on Health Insurance: 24 Sep 2005

Central State Corporate Personal Total

Primary care 4.3 5.6 0.8 48 58.7

Inpatient 0.9 8.4 2.5 27 38.8

Non service 0.9 1.6 na na 2.5

TOTAL 6.1 15.6 3.3 75 100

““Doctor, do you think I need an MRI?”Doctor, do you think I need an MRI?”

Self-reported assessment of medical practices

Aspects of Practice

Fee-splitting practices

Over-prescription of drugs

Over-prescription of diagnostics

Inadequate sterilization of medical equipment

Inadequate measures of disposal of waste

Inadequate fulfilment of standards

Inappropriate use of medical technology

Breakdown of trust in doctor-patient relationship

Inadequate information given to patients

Lack of accessibility during emergencies

Prevelance – High

24

25

14

12

31

5

4

14

15

12

The Baby DoomThe Baby Doombyby

Kavery NambisanKavery Nambisan• The couple sitting opposite me in the

clinic are young and wealthy. She is three months into her third pregnancy and wants to know the sex of the unborn baby. Their two bright-eyed daughters aged four and two are playing outside. I explain. It is against the law; the number of girls in our country is dwindling; all-girl families are often high achievers. The husband's patience begins to wear thin. They leave my clinic with the frown of those who will not come back

to me. I find out later that the woman "miscarried" in Bangalore.

Public Empowment

• A doctor can be held liable under the Consumer Protection Act, 1986, for deficiency of service.

• Disciplinary action can also be brought against them under the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002

ObjectivesObjectives

• Context: general and health

• Emerging health care trends

• Critique of above

• Suggestions for the way forward

Emerging trends in health care in Emerging trends in health care in IndiaIndia

Poverty and Social OpportunityPoverty and Social Opportunity

Yet even a hundred Bangalores and Hyderabads will not, on their own, solve India’s tenacious poverty and deep-seated inequality. The very poor in India get a small – and basically indirect – share of the cake that information technology and related developments generate. The removal of extreme poverty, calls for more participatory growth on a wide basis, which is not easy to achieve across the same barriers of illiteracy, ill health, uncompleted land reforms and other sources of severe societal inequality. The process of economic advance cannot be divorced from the cultivation and enhancement of social opportunities over a broad front.

India Shinning

“India is shining ok for the glossy magazines, but if you just go outside Bangalore you will see that everything about India shining is refuted … [In the villages] alcoholism is rife and femaie infacticide and crime are rising. You have to bribe to get electricity, water. Yes, the middle and upper classes are taking off, but the 700 million who are left behind, all they see is gloom and darkness and despair. They are born to fulfil their destiny and have to live this way and die this way. The only thing that shines for them is the sun, and it is hot and unbearable and too many of them die of heatstroke.”

Health Care in India: summary Health Care in India: summary assessmentassessment

• Safety• Timeliness• Effectiveness• Efficiency• Equitable• Patient Centeredness

Basic health care is a privilege not a right

Health Care in India: summary Health Care in India: summary assessmentassessment

• BUT…..

Reasons to be optimistic

Defining TrendsDefining Trends

• Indian Economy is GLOBALISING

• Indian Politics is REGIONALISING

• Indian Society is LOCALISING

These are mutually reinforcing and positive trends …..

ObjectivesObjectives

• Context: general and health

• Emerging health care trends

• Critique of above

• Suggestions for the way forward

Areas for collaborationAreas for collaboration

WIIIFM (What Is In It For Me) Test

• Philanthropy

• Money

• Curiousity

Need

Need

Supply

Supply

IndiaIndia

SpainSpain

Areas for collaborationAreas for collaboration

• Intellectual capital: policymaking/insurance/management/IT

• Workforce: Clinical and non-clinical

• Goods/manufacturing: Equipment/Medicines

• Infrastructure: Population base for R & D/PH system