Presented by:Varsha Sharma M.SC.(N)1st yr.

HEALTH CARE REFORMS

HEALTH CARE REFORMS:

• Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place.

OBJECTIVES

Expand the array of health care providers

Improve the access to health care specialists

Improve the quality of health care

Give more care to citizens

contd:

Broaden the population that receives health care coverage through either public sector

insurance programs or private sector insurance companies

Decrease the cost of health care

TOP REASONS TO SUPPORT HEALTH CARE REFORM:

Ends DiscriminationFor Pre-existing Conditions

Ends Dropping of Coverage for Seriously Ill

Ends Cost-Sharing for Preventive Care

Ends Exorbitant Out-of-Pocket Expenses

Ends Gender Discrimination.

Guarantees Insurance RenewalExtends Coverage for

Young Adults

Ends Annual or Lifetime Caps on Coverage

HEALTH CARE REFORMS IN INDIA

COMPREHENSIVE CARE- Bhore committee 1946

• Provide adequate preventive, curative and promotive health services.

• Be as close to the beneficiaries as possible.• Widest cooperation between the people,

the service and the profession.

contd:

• Is available to all irrespective of their ability to pay

• Look after specifically the vulnerable and weaker sections of the community

• Create and maintain healthy environment both in home as well as working places

BASIC HEALTH SERVICES

• A basic health service is understood to be a network of coordinated, peripheral and intermediate health units capable of performing effectively a selected group of functions essential to the health of an area and assuring the availability of competent personnel and auxiliary personnel to perform these functions

PRIMARY HEALTH CARE

• The Alma-Ata international conference gave primary health care a wider meaning Primary health care is essential health care made universally accessible to individuals and acceptable to them , through their full participation and at a cost the community and country can afford

PRINCIPLES OF PRIMARY HEALTH CARE

Equitable distribution

Community participation

Inter sectoral coordination

Appropriate technology

ISSUES IN HEALTH CARE REFORMS

UNEQUAL DISTRIBUTION OF

HEALTH CARE RESOURSES

PRIVATE HEALTH CARE AND ECONOMIC

INEQUALITY

ISSUES IN HEALTH CARE REFORMS

1. UNEQUAL DISTRIBUTION OF HEALTH CARE RESOURSES

• The ratio of hospital beds to population in rural areas is fifteen times lower than that for urban areas

• The ratio of doctors to population in rural areas is almost six times lower than that in the urban population

CONTD:

• Per capita expenditure on public health is seven times lower in rural areas, compared to government health spending for urban areas

• The most peripheral and most vital unit of India’s public health infrastructure is a primary health centre (PHC)

• In a recent survey it was noticed that only 38% of all PHCs have all the essential manpower and only 31% have all the essential supplies (defined as 60% of critical inputs), with only 3% of PHCs having 80% of all critical inputs.

• Though the spending on healthcare is 6% of gross domestic product (GDP), the state expenditure is only 0.9% of the total spending. People using their own resources spend rest of it. This makes the Indian public health system grossly inadequate and under-funded.

• Only five other countries in the world are worse off than India regarding public health spending (Burundi, Myanmar, Pakistan, Sudan, Cambodia). As a result of this dismal and unequal spending on public health, the infrastructure of health system itself is becoming ineffective.

ACCESS DIFFICULTIES TO HEALTH CARE

Geographical distance

Socio-economic distance

Gender distance

ISSUES IN HEALTH CARE REFORMS

2. PRIVATE HEALTH CARE AND ECONOMIC INEQUALITY

• The growth of private healthcare sector has been largely seen as a boon, however it adds to ever-increasing social dichotomy. The dominance of the private sector not only denies access to poorer sections of society, but also skews the balance towards urban-biased, tertiary level health services with profitability overriding equality, and rationality of care often taking a back seat.

CONT…

• The increasing cost of healthcare that is paid by ‘out of pocket’ payments is making healthcare unaffordable for a growing number of people. The number of people who could not seek medical care because of lack of money has increased significantly between 1986 and 1995

CONT…

• The proportion of people unable to afford basic healthcare has doubled in last decade.

• One in three people who need hospitalization and are paying out of pocket are forced to borrow money or sell assets to cover expenses.

• Over 20 million Indians are pushed below the poverty line every year because of the effect of out of pocket spending on health care.

CONT..

• In the absence of an effective regulatory authority over the private healthcare sector the quality of medical care is constantly deteriorating.

PROS OF HEALTHCARE REFORMS

Becoming more

efficient

New model of care

Helps the bottom line

CONS

Administrative costs

CoverageCut in payments

SUMMERIZATION

RECAPTUALIZATION