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HEALTH POLICY IN INDIAPresented by :ARIF KHAN

1CONTENT:HISTORY OF Public Health in IndiaHealth System in IndiaPRIMARY Health care systeMHEALTH INSURANCE IN INDIAHealth Financing in India

2HISTORY OF Public Health in IndiaHealthThe World Health Organisation defines Health (of an individual) as the state of complete physical mental and social well-being and not merely the absence of disease or infirmity.

World Health Organisation, however, does not define Public Health.DeathDeath, on the planet Earth, is inevitable.

A large number of deaths are premature.

A substantial proportion of deaths can be avoided.

Public Health is related to preventing premature and unavoidable deaths.A Model of HealthExposure to Risk FactorsBody resistancePoor HealthManifestationDisease ConditionDisabilityDeathPublic HealthPublic Health deals with the group of people rather than individuals.Dimensions of public healthHealth promotionDisease preventionEarly diagnosis and prompt treatmentDisability limitationRehabilitationTraditional Indian ApproachThe Indian approach to health is enshrined in the concepts and principles of Ayurveda which means the science of life.Ayurveda is one of the oldest system of health care in the World.Ayurveda deals with both preventive and curative aspects of health.Health defined by WHO is very similar to concepts of Ayurveda.Western ApproachThe western approach of avoiding diseases, death and disability, traditionally focused on personal hygiene and public sanitation during the 19th Century.

This approach, combined with better food availability, paid rich dividend in the developed countries in reducing morbidity and mortality.Components of Public HealthEpidemiologyMeasurement of disease conditions in relation to the population at risk. StatisticsCollection, presentation, analysis and interpretation of epidemiological data.Health ServicesServices directed towards meeting the health needs of the people.Public Health in Independent IndiaEvolution of public health care system in Independent India was shaped by two important factors:The Report of First Health Survey and Development Committee (Bhore Committee) constituted during the colonial rule.Emergence of modern medical technology for the prevention and control of diseases, especially communicable diseases.Bhore CommitteeAppointed in 1943.Recommended comprehensive remodeling of health services.Integration of preventive and curative health services at all levels.Hospital-based health care system.Development of primary health centres in two stages.Training in Preventive and Social Medicine.

Bhore CommitteeThe short-term planA PHC for every 40000 population.PHC to be manned by 2 doctors, 4 PHN, 4 Midwife, 1 Nurse, and others.The long-term planA primary health unit for every 10-20 thousand population with 75 beds.Secondary unit with 650 bedded hospital.District unit with 2500 bedded hospital.Public Health in Independent IndiaThe recommendations of Bhore Committee and the availability of preventive and curative medical technology resulted in the evolution of hospital-based public health system.The public health arrangements created during the colonial period were replaced by hospitals and health centres.Public health services were merged with the medical services.Public Health in Independent IndiaBhore Committees recommendations were accepted only partially.One primary health centre for every 30 thousand population.Only 6 beds in each primary health centre.Only one doctor.Truncated paramedical staff.The situation has remained largely unchanged.Public Health in IndiaMukherjee Committee (1965)Separate staff for family planning programme.Malaria activities to be de-linked from family planning activities.Jungalwala Committee (1967)A unified approach for all problems instead of a segmented approach for different problems.Medical care and public health programmes to be put under charge of a single administrator.Public Health in IndiaBajaj CommitteeFormulation of National Medical & Health Education Policy.Formulation of National Health Manpower Policy.Educational Commission for Health Sciences.Health Science Universities in various states.Health manpower cells.Vocationalisation of education at 10+2 levels as regards health related fields.Realistic health manpower survey.

Public Health in IndiaPublic health in India is hospitalised.Health planning is concerned more with the health of the health care delivery system (hospitals and health centres) then the health of the people.The remedy was sought in terms of specific National health and disease control programmes.There are numerous such programmes.

Public Health in IndiaReproductive and child health programme.National tuberculosis control programme.National malaria control programme.National blindness control programme.National water born disease control programme.National leprosy eradication programme.National iodine deficiency control programme.Public Health in IndiaAll National disease control programmes are implemented through the existing government hospitals and health centres.Over the years, a campaign approach has been evolved to implement many of the national health and disease control programme.Successful campaigns have often been followed by unsuccessful maintenance.Public Health in IndiaFocus on medical services.Neglect of public health services.No modern public health regulation.Lack of systematic planning.Poor sustainability of public health efforts.Absence of epidemiological and statistical skills at district and below district level.No micro-level planning, no public health action.Essential Public Health Functions

Essential Public Health Functions in IndiaHealth System in India

IntroductionThe political economy contextThe organisational structure and delivery mechanismHealth financing mechanisms Coverage patterns Current status of health and health careThe Political Economy ContextA democratic federal system which is subdivided into 28 States, 7 union territories and 593 districtsIn most of the states three local levels of government (Panchayati-raj)Per capita income US $440435 million Indians are estimated to live on less than US $ 1 a day36% of the total number of the worlds poor are in India Tax based health finance system with health insurance 80% health care expenditure born by patients and their families as out-of -pocket payment (fee for service and drugs)Expenditure on health care is second major cause of indebtedness among rural poor

Characteristics of Indian Health SystemComplex mixed health system

- Publicly financed government health system - Fee-levying private health sectorDifferent Phases of Indian Health System Development Pre-independence phaseDevelopment centred phase Comprehensive Primary Health Care phaseNeoliberal economic and health sector reform phaseHealth systems phaseMain Systems of MedicineWestern allopathicAyurvedaUnaniSiddhaHomeopathy Government Health SystemThree levels of responsibilities-

First- health is primarily a state responsibility

Second- - the central government is responsible for developing and monitoring national standards and regulations - sponsoring various schemes for implementation by state governments - providing health services in union territories

Third- both the centre and the states have a joint responsibility for programmes listed under the concurrent list. Administrative Structure

1. Central Ministries of Health and Family Welfare - Responsible for all health related programmes - Regulatory role for private sector 2. State Ministries of Health and Family Welfare 3. District Health Teams headed by Chief Medical and Health Officer

Service Delivery StructureSub Health Centres- staffed by a trained female health worker and/or a male health worker for a population of 5000 in the plains and a population of 3000 in hilly and tribal areas. Primary Health Centres- staffed by a medical officer and other paramedical staff for a population of 30,000 in the plains and a population of 20,000 in hilly, tribal and backward areas. A PHC centre supervises six to eight sub centres.

Service Delivery StructureCommunity health centres- with 30-50 beds and basic specialities covering a population of 80,000 to 120,000. The CHC acts as a referral centre for four to six PHCs. District/General hospitals- at district level with multi speciality facilities (City dispensaries) Medical colleges, All India institute of Medical Sciences and quasi government institutes (NIHFW and SIHFWs)

Health Financing Mechanisms..Revenue generation by taxOut of pocket payments or direct paymentsPrivate insuranceSocial insuranceExternal Aid supported schemes

Spending on HealthAnnually over 150,000 crores or US$34 billion, which is 6% of GDP (Government spending on health Is only 0.9% of GDP)Out of this only 15 % is publicly financed 4% from social insurance, 1% by private insurance remaining 80% is out of pocket spending ( 85% of which goes in private sector)Only 15% of the population is in organised sector and has some sort of social security the rest is left to the mercy of the marketThe Aspects of Neoliberal Economic Reforms Affecting Public Health Increasing unregulated privatisation of the health care sector with little accountability to patientsCutting down government Health care expenditureSystematic deregulation of drug prices resulting in skyrocketing prices of drugs and rising cost of health servicesSelective intervention approach instead comprehensive primary health careMeasure diseases in terms of cost effectivenessTechno centric approach( emphasis on content instead processes)ContradictionsIndia has the largest numbers of medical colleges in the worldIt produces the largest numbers of doctors among developing countries It gets medical Tourists from developed countries This country is fourth largest producer of drugs by volume in the world But... the current situation.Only 43.5% children are fully immunised.79.1% of children from 6 months to 5 years of age are anaemic.56.1% ever married women aged 15-49 are anemic. Infant Mortality Rate is 58/1000 live births for the country with a low of 12 for Kerala and a high of 79 for Madhya Pradesh.Maternal Mortality Rate is 301 for the country with a low of 110 for Kerala and a high of 517 for UP and Uttaranchal in the 2001-03 period. Two thirds of the population lack access to essential drugs. 80% health care expenditure born by patients and their families as out-of -pocket payment (fee for service and drugs)Health inequalities across states, between urban and rural areas, and across the economic and gender divides have become worseHealth, far from being accepted as a basic right of the people, is now being shaped into a saleable commodityContd.poor are being excluded from health services Increased indebtedness among poor (Expenditure on health care is second major cause of Indebtedness among rural poor)Difference across the economic class spectrum and by gender in the untreated illness has significantly increased Cutbacks by poor on food and other consumptions resulting increased illnesses and increasing malnutrition

Health InequitiesThe infant mortality Rate in the poorest 20% of the population is 2.5 times higher than that in the richest 20% of the populationA child in the Low standard of living economic group is almost four times more likely to die in childhood than a child in a better of high standard living groupA person from the poorest quintile of the population, despite more health problems, is six times less likely to access hospitlisation than a person from richest quintile.

Health InequitiesA girl is 1.5 times more likely to die before reaching her fifth birthdayThe ratio of doctors to population in rural areas is almost six times lower than that for urban areas.Per person, government spending on public health is seven times lower in rural areas compared to government spending urban areas

PRIMARY Health care system in india

Health :- A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.Introduction :-

Health care system is initially started from central government of India. The scope of health services is varies widely from country to country and influenced by general and ever changing national, state And local health Problem, need attitude as well as available resources.

45Health care should be :-Accessible

Acceptable

Provide scope for community participation

Comprehensive

Affordable at low cost 464647Resources:-

Man power

Money power

Material power

48Organization and administration of health services in india at different level.National level

State an union territories District health organization and basic specialties hospital/districts Community health sub-districts/Centers taluka hospital

P.H.CSub centers Village health Guides

People inPopulation At central level:-

Union ministry of health and family

The director general of health services

The central council of health and family welfare 50Union ministry function International heath relation and administor of port-quarantine

Administration of central health institutes such as all India institute of hygiene Promotion of research through research centers and other bodies

Regulation and development of medical, nursing and other allied health promotion

Establishment and maintains of the drug

Census and collection and publication of other statistical data

Immigration and migration

Regulation of labor in the working in mines 51Director general of health services General function :-the general function are survey planning, co- ordination, programme and appraisal of all health matters in the country Specific funtion :-international health relation and quarantinecontrol of drug standardsmedical stores depots post graduation training medical education medical research central govt. health scheme 52Central council health function are :-

Environmental hygiene, nutrition, education, promotion, research

Making the proposal

Distribution sources to the state level

Promoting and maintain between central and state level Panchayti Raj :-

it is rural administration It is last phase in the system of the health care structure Three institution of panchayati Raj are following:-

Panchayat :-(at village level)

Panchayat Samiti:- (at block level)

Zilla parishad :- (at district level)1)Panchayat :-Gram sabha:-They meet at least twice in a year and elected the member of gram panchayat gram panchat :- it constitude on the popullation of 5,000 to 15,00015 to 30 panch as membersHeaded by surpanch It term upto 3 to 5 year nyaya panchat it villages platform to resolves the disputes between villages /local group Mainting peace among people 2)Panchayat samiti :-It consist of 100 villages

Covering 80,000 to 1 lack people

It consist of all surphanchs

B.D.O.headed 3) Zilla parishad at the district level collector also member of this team but not right of voting Nearest 70 to 80 members

Mainly supervising by collector 56Primary health care :- Launched in 1977 base on rural health scheme

The principle is placing people health in people hand

1983 national health policy based on PHc approved by parliament 1)Village level a) village health guide scheme b) training of local dais c) ICDS scheme(Anganwadi worker)2)Sub centre 3)P.H.C 57a)Village level one of the basic tends of primary health care. implement the policy of primary care following scheme are operating:-Village health guides:- a person with an aptitude for social services and it not full time government functionary.

This scheme introduced on 2nd oct 1977

In May 1986 male guide replaced by female health guides They provide the first contact between the individual and the health systems

58The guidelines for their selection are:-

they should be permanent residents of the local community, preferably women they should be able to read and write having minimum formal education at least 10th standard Should be accept all section of the community They should be spare at least 2 to 3 hrs every day

Training for health guide:-At the PHCDuration 200 hrs for 3 months received stipend Rs. 200/month

59Providing knowledge and training Knowledge is emphasize on elementary concepts of maternal and childhealth and sterilization

The training is 30 working days

Anganwadi worker

One anganwadi for 1000 people popullation

Under ICDS

Local dais:-

60Sub-center level:- it is peripheral outpost of the existing health delivery systems in rural areaOne sub centre .Every 3000 population in hilly and tribal Each sub-center one male/female ANM

Primary health center level In 1946 Bhore community put the concept of P.H.C.One P.H.C. for 30,000/25,000

61Function of P.H.C. Medical care MCH including family planning Safe water supply and basic sanitation Prevention and control of locally endemic disease collection and reporting of vital statistic Education about health National health programme as relevantReferral servicesTraining of health guides health workers local dais and health assistants Basic laboratory services (tubectomy vasectomy and tracheotomy MTP and minor surgery)

62 Health care female:-

Registration:- Pregnant women Married women Number of home visits

Care at home:-Care of pregnant womenAdvice about nutrition and food hygiene Distributes iron & folic acid tab Immunization Finding gynecological problem Family planning 63Supervises deliveries First Aid in emergency Notify disease Record and reports of birth\death Test urine albumin Distribute conventional contraceptive

Care at clinic arrange help to M.O.Conduct MCH Family planning clinic at sub centre

Care in the community Participant in mahila mandal meeting Helping to other staff other :- maintain cleanliness of centre Attend staff meeting at P.H.C.List the dais of same area Co- ordinating 64Health worker male:- Record keeping

Malaria (identification, O.P.D. investigation, records, control of spreading,education,followup) Communicable disease

Leprosy

Tuberculosis

Environmental sanitation

Expanded programme on immunization

Family planning

65 hospital health centers :-Community health centers:-31st march 2003 established by upgrading the primary centers Covering 80,000 to 1.2 lack population30 bedsSpecialist surgery

C.H.C has provided following services :-Care routine and emergencies cases in surgery Care of routine and emergencies in medicine24 hrs delivery services Cesareans sectionFull range of family planning services, laparoscopy too. safe abortion New born careTracheotomy, nasal pack National health programme Other 66 Rural hospital :-Its convert the sub division hospital into sub division health center .Covering 5 lacks population In this covering P.H.C., sub centre, at tehsil/sub division/ taluka . P.H.C. patient are shifted for infusion level District hospital its convert the district hospital into district health centre hospital differs from health centre in the following respect mostly curative services No catchment areaMix team work 67 Specialist hospital :-The specialist hospital include:- trauma centers Rehabilitation hospital Seniors (geriatric) care Psychiatric hospital Cardiac Oncology etc.Hospital may in a single or number of building on one campus It may expensive or not expensive too. Teaching hospital:- providing clinical education and training to future Provide medical education to the doctor, nsg, health profession In additional providing patient care. 68Other agencies :-Defense medical services:- it is largest and almost best organization of health care systems in the country Supported facilities:-Ambulance Mobile bedsHospital (all)Staff (doctors,nsg,co-workers)Health care of railway employee:-Through out railway hospital care are provideMCHSchool health services Specialist unique hospital Primary careHealth check-up 69Medical officer are working in sub-division centre The economical sources are providing by railway department for future care at the low cost. Private agencies:-

In a mixed economy such as India's private practice of medicine a large share of health services available

The general practitioner constitute 70% of the medical profession

The component of private agencies are poly Nsg home, general practitioner Indigenous systems :-

the practitioner of indigenous systems of medicine are ayurveda.sidha,homoepathy

90% of ayurvedic physician serve the rural area

The govt. of India is studying best utilized for more effective or total health coverage.Voluntary health agencies:-

Definition:-

An organization that is administrated by an autonomous board which holds meeting collects funds for it supported chief from private sources and expanded money.Function :-Supplementing the work of govt agencies Pioneering

Education Demonstration

Guarding work of govt. agencies

Advancing health legislation Health programme in India:-

Since india become free several measure have been undertaken by the national govt.

Central govt. for control eradication of communicable disease, improved environmental sanitation etc.

India given permission to the foreigner countries to implement them organization in india Factor influencing :-

Demographic trends:-Population explosion Declining mortality for both sex Increasing old age and midline age peoplePrevalent of non- communicable disease Higher morbidity rates Eliminating communicable disease social trends:- changing of life styles Appreciation of quality of life Changing families composition and living pattern Rising household incomes 74Economic trends:-Improved in std of living Training facilities Allotment of social welfare funds to other job opportunities Self employment schemeIncreasing nurses in hospital and non hospital settingImpaired family planning political trends :-policy changes Supports (economic, attitude) HEALTH INSURANCE IN INDIA

ITS AFFORDABILITY & ACCEPTABILITY HAS TO BE ASSURED FOR URBAN A/W/A RURAL, WELL TO DO TO THE POORER SECTION OF THE SOCIETY.

HEALTH IS A HUMAN RIGHT76Health is a human right, which has also been accepted in the constitution. Its accessibility and affordability has to be insured. While the well-to-do segment of the population both in rural & urban areas have acceptability and affordability to wards medical care, at the same time cannot be said about the people who belong to poor segment of the society. It is well known that more then 75% of the population utilizes private sectors for medical care unfortunately medical care becoming costlier day by day and it has become almost out of reach of the poor people. Today there is need for injection of substantial resources in the health sectors to ensure affordability of medical care to all. Health insurance is an important option, which needs to be considered by the policy makers and planners.

AgendaHealthcare and health insurance in IndiaMacroeconomic trends and indicesCurrent schemes and coverageGlobal experience and the objectives of health insurance reformDevising an appropriate model for IndiaSegmenting the marketFramework for reformManaging the reform process77. Health Care scenarioBefore independence - dismal condition.High morbidity, mortality and Infectious diseases.After independence - emphasis on PH care.Present Problem-High mortality, negligible MCH care.Urban-Rural divide:70:30.Population Size of the country.Declining funds to HealthCare Sector-CG/State.

78HEALTH CARE SCENARIO: Health care has always been a problem area for India, a nation with a large population and a larger percentage of this population living in urban slums and in rural area, below the poverty line. Before independence the health structure was in dismal condition i.e. high morbidity and high mortalities, and prevalence of infectious diseases. Since independence emphasis has been put on Primary Health Care and we have made considerable progress in improving the Health Status of the country.CG:Central GovernmentPH:Primary Health MCH:Maternal and Child HealthHealth Care Scenariocontd At any given point of time 40 to 50 million of population on medication for major sickness. About 200 million days are lost annually. The annual rate (range) of out-patient: rural 30-152/1000, urban 9-81/1000 and for hospitalization: rural 16-76/1000, urban 5-38/1000.

The share of public financing in total health care is just about 1% of GDP compared to 2.8% in other developing countries.Beneficiaries are both poor a/ w/ a well-fed section of society.Over 80% of the total health financing is private financing,much of which is out-of-pocket payments (i.e. User charges) and not any prepayment schemes.

HEALTH CARE FINANCING IN INDIA80a/ w/ a: as well as2004USUKMexicoBrazilChinaIndiaLife expectancy (avg. # of years)77.478.372.671.472.564.0# of Physicians per 1,000 people2.71.91.71.21.70.4Healthcare spend (USD per capita)5,3653,0363362366232Healthcare spend (% of GDP)13.28.45.57.55.05.3Health care spend in India is considerably lower than that in other countries81Access to health care service providers and availability of physicians is one part of the issue

Financing for health care is the other aspect of the issue

The proportion of insurance in health care financing in India is extremely low

86% from out-of-pocket expenses 83% from private sector spendingHealth care financing in India 2002, %82Public spending in health care is very low at 17% and the National Health Policy has recognized thisMore than 86% of healthcare financing is through unplanned for, non-contributory spending

The World Health Organization has defined possible approach to financing of health expenditureTotal health expenditurePublicPrivateSocial securityExternally fundedTax-fundedPrivate health ins.Externally sourcedOut-of-pocketUsing central / state revenues for health

Compulsory premium contributions to healthChanneling loans, grants etc. to healthcarePayments to health care providers for servicesPremium contributions towards health supportChanneling donations etc. to healthcare83Tax-based and out-of-pocket expenses are direct expense related outlays

Health insurance involves a fund pool for future health careExternal fund sources rely on donations, grantsSocial Security: ConceptDefined as the security that the society furnishes to some organizations against certain risks to which the members of society are exposed

Social Security: Advantage

The financial burden of sickness cannot be borne by the individual. It must be widely distributed throughout the country.Sickness is not an individuals misfortune but the calamity is to taken as community & state responsibility.

Health insurance typically helps a patient manage health care costs beyond a threshold amount through pooling As a contingent claim instrument, health insurance is an efficient way to help individuals prepare for health care

Insurer payment(from premium pool)Individual paymentDeductibleCo-insuredHealth care expenditure (INR)Patient expenditure (INR)Stop-loss level86WHAT IS HEALTH INSURANCE? SYSTEM OF ASSURANCE TO MAKE CONTINGENCIES OF HEALTH CARE EXPENSES.TO PROVIDE PROTECTION AGAINST FINANCIAL LOSS BY UNFORSEEN SICKNESS.TO MEET COST OF GOOD MEDICAL CARE.RELIEVES ANXIETY AND TENSION.

Origin of Health Insurance:International1883 Bismarck- sickness benefit to workers.1911 Lloyd George- National Health Insurance Scheme to cover sickness expense, medical relief, drugs & compensation of wages lost, to improve quality of life and improve industrial production.J.F.Kimball: prepayment system of health care.Origin of Health Insurance: National:1923: Workmans compensation Act.1948: ESI Act passed.1952: First ESI hospital established.Mudaliar Committee(1959-1961) recommendations:Long range health insurance policy for all.Small fee for availing health services.

Origin of Health InsurancecontdNational:1999: IRDA act passed.2001: Insurance amendment Act: Emphasis on TPAs.

Forms of Insurance AvailableIndemnity Insurance: where the insurer first pay to the hospital and claim is made. E.g. Jeevan Asha II, Asha Deep II, Mediclaim.Cashless Claim Facility:TPAs who bear the expenses on behalf of insurance company. Patients need not to pay directly as a rule e.g. Bajaj Alliance.CBHI (Community Based Health Insurance).

The key issue related to financing of health care in India revolves around the lack of adequate insurance . . .Limited coverageOnly around 10% of the population is covered through health financing schemesGeographic spread in terms of health care facilities and financing awareness is limitedSelection criteria by suppliers often restricts the poor (and more likely to be ill) from affordable pre-payment schemesMoral hazard and Adverse selectionClaims ratios for Mediclaim and Jan Arogya policies have been in the range of 120 130%.92The extent of coverage as well as the type of coverage are the key issues related to insurance penetration

The key issue related to financing of health care in India revolves around the lack of adequate insurance contdSystem leakagesProvider malpractices leading to over-charging or pre-selection / selective recommendationLack of universal schemesLimitations in terms of coverage of illnesses as well as treatment options Alternative therapies often not considered / included under insurance

93Some companies have put-off plans for India due to potential leakages in the system

Global experience provides some key learning on health insurance policy design Balancing risk-spreading and incentives offeredBalancing the need to encourage health insurance against moral hazard (individuals choose more care) and principal-agent problems (providers supply more care)Integration of insurance and health care provisionManaging doctor loyalties with patient and insurer under managed care

94Various economic studies have suggested some key learning around health insurance policy design

Global experience provides some key learning on health insurance policy design . . .contdApproach to competition and portabilityBalancing the need for consumer choice against adverse selection (sick preferring more generous plans)Focus on health as against financing of health careThe over-riding objective should be to improve health rather than the financing of health care services

95Various economic studies have suggested some key learning around health insurance policy design

Some key considerations related to formulation of approach to HI in India . . .Differential approach -Formal sector (government and non-government workers)Self-employed segmentPoor / Unemployed segmentScope and structure of health insurance coverProduct and segment coveragePortability across service providersCap on premium amountsRisk-adjusted approachNature of fiscal incentivesSubsidies and tax incentives for health insurance as against health care96The approach to health insurance in India must take into account specific considerationsAs a result, the traditional model for health insurance needs to change...IndividualInsurer/ProviderGovernment / EmployerFixed feesService chargesVoluntary premiumsMandatory premiumMandatory premiumCosts up to deductibleCould be allied to insurer or be a government approved providerInter-mediariesTPAs etc.Financial flowsService flows97The traditional model has focused on insurers or intermediaries working with the employed segment only as the front-end

to one that allows the flexibility to serve different segments of the population, in an efficient manner Health insurance providers may need to align themselves to overall health care including financing, preventive health care and health outreach in order to grow coverage

Regulations and policy must be designed to encourage thisCommunity-based initiatives have been particularly cost- efficient in reaching out to the poor / unemployed segmentsRole in Community-based health initiative (CBHI)Health intermediaryHealth managerHealth providerExample of some CBHIs / NGOsSEWA / ACCORDTribhuvandas FoundationSewagram / VHSNature of health risk coveredInpatient, non-health relatedInpatientInpatient, OutpatientAccess to benefitsAfter certain periodAt time of dischargeAt time of utilizationAdministrative costsModerateLowLowNature of pool formationOccupation / geography-basedOccupation / geography-basedGeography-based99Typical administrative costs associated with health insurance are around 20% of premium but could fall to 5 6% under CBHIs

CBHIs must however be designed to target specific segments

How CBHI can be made ReachableEffort for social mobilization & strengthening of people organizationTraining and capacity building, special emphasis on PRIs and Women OrganizationDemand Driven social services, Building of alliances and partnershipsAdvocacy for Pro poor policies.

Managing the reform process would require several infrastructural and market changes to be effectedAppropriate market segmentation, awareness initiatives, product innovation, and incentivesEasing of entry norms for specialist health insurance companiesProvider rating and credentialingCentralized database for health insurance experience statisticsEfficient back-office support for underwriting and claims processing101An appropriate health infrastructure is an essential pre-requisite to health insurance reformHealth insurance is an emerging important financial tool in meeting health care needs of the people of INDIA. CBHI is to be further explored so that the disadvantaged section get maximum benefit. In India at present no Pan-India Model of HI.All different forms need to be explored.Conclusion

Thank you for patience