RMRS Rajasthan

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Text of RMRS Rajasthan

RMRS Rajasthan RMRS RajasthanSate Institute of Health & Family Welfare, Jaipur1SIHFW: an ISO 9001: 2008 certified InstitutionH l h I & Ch ll Health care: Issues & ChallengesN l t d i it N t i Neglected priority-Not a core governance issue Policy-36 yrs No sub-centre till 1971 % of GDP Declining on a regular basis State subject -central dictate Human Resource Human Resource Shortage/ vacancies/ absenteeism Training/ Capacity buildingL it f f d tili ti Low capacity of fund utilization Poor management support2SIHFW: an ISO 9001: 2008 certified InstitutionChallenges g Manpower- Number & Norms Rural / Urban differential Geographical divide across States Geographical divide across States S-E groups accessibility/ reach Gaps between Policy & Action Health sector expenditure Health sector expenditure Newer Infections 3SIHFW: an ISO 9001: 2008 certified InstitutionWho pays? Health Authority? Government?T ? Taxpayer? 4SIHFW: an ISO 9001: 2008 certified Institution1377Health Care Spending (2004-05)Source: NCMHGI, 2005120014001377Source: NCMHGI, 200510001200808India Rajasthan600800400020073.5224.57024.5 5.5Per capita expenditureHousehold Public Other5SIHFW: an ISO 9001: 2008 certified InstitutionI i H l h fi i Issues in Health financing:Reduce out of pocket payments Reduce out-of-pocket payments Increase the accountability towards health care provision Risk pooling & Risk sharing Risk pooling & Risk sharing. 6SIHFW: an ISO 9001: 2008 certified InstitutionRationing of Health careEconomics concerned ith choice bet een Economics concerned with choice betweencompeting alternatives Based on axiom of scarcity resources limited Based on axiom of scarcity - resources limitedrelative to wants Fundamental economic problem is therefore Fundamental economic problem is thereforeallocation of these scarce resources Rationing (priority-setting) just another term for Rationing (priority setting) just another term forresource allocation7SIHFW: an ISO 9001: 2008 certified InstitutionTaking care of cost: what to do Ensure stable financing mechanism Enhance financial protection and social safety p ynets. Achieve more resource allocation andt di t ff ti h lth government spending on cost effective healthinterventions Improve institutional capacity and capability in Improve institutional capacity and capability inbudgeting, pricing, financial planning andmanagement8SIHFW: an ISO 9001: 2008 certified InstitutionFinancing options for Health g p Public investmentG t Govt. revenue TaxesDebt financing Debt financing Private investmentPublic Private Partnership Public Private Partnership Public goods Ownership issue Ownership issue User fee Risk transfer9SIHFW: an ISO 9001: 2008 certified InstitutionHealth financing Early 1980sPay clinics Pay clinics Auto finance scheme(1982) Revenue went to StateDid l Did not last10SIHFW: an ISO 9001: 2008 certified InstitutionPPP: Why y9Improve access without substantialinvestment from public sector.9Adopt best practices 9Adopt best practices9Opportunity to increase reach9Opportunity to regulate the private sector9N d b d T il d i 9Need based Tailored services9Competition opens Options for poor11SIHFW: an ISO 9001: 2008 certified InstitutionApproaches to PPP in Rajasthan RMRS Policy Policy Contracting in- BOO, BOT (Radio-Imaging Contracting out-Support services12SIHFW: an ISO 9001: 2008 certified InstitutionAntecedents: 1994: Plague in Surat 1995: cleaning drive at MY hospital, Indore g p , 1995: RKS in Indore13SIHFW: an ISO 9001: 2008 certified InstitutionGenesis of RMRS Cost Technological advancements Inflation Expansion of services Autonomy Payment capacity of people Health care financing mechanism14SIHFW: an ISO 9001: 2008 certified InstitutionRajasthan Medicare Relief Societies Rajasthan Medicare Relief Societies NGO-Registered society-Autonomy NGO Registered society Autonomy Self-sustainable Reducing cost of care No middle man Instrument for cost recovery (user fee) Cross subsidy to marginalized Promote PPP for capital intensive facilities Promote PPP for capital intensive facilities in Health care15SIHFW: an ISO 9001: 2008 certified InstitutionRMRS RMRS Reformatory step Registered under section 20 of Rajasthan societies Act Rajasthan societies Act Equipments transferred to RMRS Jan sahbhagita(50:50)U f i t d d User fee introduced Reimbursement rules amended 16SIHFW: an ISO 9001: 2008 certified Institution Need for User charges-1 T t th bli 1. Too many to use the public services2. Limited resources3. Increasing demand4 High recurring cost 4. High recurring cost17SIHFW: an ISO 9001: 2008 certified InstitutionWhy user charges? People misuse just because it is Free Revenue generated can improve quality Marginal sections can be better lookedafter (Cross subsidy) System can be made self sustainable to alarge extent Payment increase sense of ownership &Participation18SIHFW: an ISO 9001: 2008 certified Institution Mechanism for introducing User charges- Dual pricing Dual pricing Graded charges Exemption criteria What determines User Charges? Cost of care Cross subsidy costsf Replacement cost including inflation andrupee devaluation19SIHFW: an ISO 9001: 2008 certified InstitutionRMRS & LLFS RMRS & LLFS RMRS 1995 RMRS-1995 LLFS-Aug. 1996 No Monopoly No Monopoly Drugs identified by committee of Sr. Doctors Straight from Manufacturer/ C& F Lowest price certification by Supplier No profit No loss Equal opportunity to contractors-Open Tenders Contractor Fixed remuneration + 1%commission commission20SIHFW: an ISO 9001: 2008 certified Institution Free services to identified groupsFi ti f h 50 % f k t Fixation of user charges-50 % of market Audit mechanism Revenue retained by Facility Guidelines for utilization of revenue 50% on equipment 50% on service improvement, repair, maintenance21SIHFW: an ISO 9001: 2008 certified InstitutionObjectives Generating revenue Sustainability Cost recovery & Cross subsidy Cost recovery & Cross subsidy Upgrade facility Equipments& Maintenance & Repair Addition of facility & Services Minimum standard care & Improving quality Minimum standard care & Improving quality PPP Empowering people p g p p Citizen charter Grievance re-dressal Representation Representation Fund mgt22SIHFW: an ISO 9001: 2008 certified InstitutionRMRS structure RMRS structure(9-11 members) PHS/ Commissioner/ Collector Supdt./PMO/CMHO/BCMO Doctors(2-3) PRI(2) PRI(2) Citizens(3) NGO Associate / Institutional member23SIHFW: an ISO 9001: 2008 certified Institution i| ll-ii i ^n|i i ii - l^. l i, ll-i ^ -^i- ^i i| ll-ii| ll-ii i ^n|i i ii - l^ li -i l-in li -nili - n li, (i)-i ll-i lii| li -ni (i) l ii| li -i l-in-i;- -ni ^ li-i l-inn li, (i)- ll-i ^ -^i- lii|-i ll-ilii|-i l-in-ni (i^,ii,ii,i-n|, nn )lii| --n i -n|-ni(s) ^ i-il-^i- - ll-i^ -^i-lii|i -ll-i ^-^i- ii| -nnill-i lii|ii|, i-illii|

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- l^-^i- ni-i inl,i-il ,-ini,iini28SIHFW: an ISO 9001: 2008 certified Institutionl- s-^ l-lni | l^li l| ii;l-i | -^ , - lii li nii ii | -|ii rn i -n -^ l-ln nl-n | i^n| li -^ ; i rini . ll-i ^ -^i- -| iz. ll-i ^ -^i- i -| iis. -i ii l^, ll-i ^ -^i- -ii l^ ( ) l-i li - . ii l^ (..) l-i li, -r. lii li, i...|.| -s. i li, .i..- -/ li ll-i ^ -^i- ^i i /. li, ll-i ^ -^i- ^i, is. ln.li (l.ii.) is. li ( -^i.) -a. li (..) - a. li (..) -. li (i;.;.|.) -z. lii li () -s. iiii, -l i, -. i|i, ^i; -ilr ll-i, -r. l^-n| iri (-i) -29SIHFW: an ISO 9001: 2008 certified Institutionl- si -i nii;-| l-llin -in i ln n| ii;-| l-llin -in i ln n| ii;-| l-llin -in i ln n| . i-i ^ ;i in| |i i~, inn i i~ il| z. l^li iiii ^ l^ii ii i~|s. l^li ^ii | ii i;.|.. i | i|^ l^li- ^ii i~ ^ l^li- ^ii i~. i- ^i,-i ^i, i,lnli nr il i lii|r. -l n --i in lii i ili| i;--i lnln ;i^ ^ii | i i| -ni - ii| i n||s. i;l --, -|, .-|.|. i il l^i ili| l l l l l /. ii , il-il- ^ l-l-ni i lii|s. l^li -ii i|s. ll^i i- l^ ili, ii ^ ii n ili| , |a. in| i-i | |i-| in ili|30SIHFW: an ISO 9001: 2008 certified Institution. i, i| i ^ l^li l^-n| -iii | l , i. .|. ii il ~i|z. |.i.-|. -i| nii i -| ^ii|l | l l l l s. l| ln ii liiiilii li i ^iii~| l | l . r~i ;i in ii li | ili|r. i-| ni-|i -^i- l-i in -i; | | | l l s. ii-| ,ii -ii| -n l^ln -in|31SIHFW: an ISO 9001: 2008 certified InstitutionFunding sources for RMRSG f S G / Grant-in-aid from the State Government and/or State level society (societies) in the health sector and/or District Health Society and/or District Health Society. Grants and donatio