Three peers who can help India make a success of Ayushman Bharat
As the country prepares to roll out the world’s largest universal healthcare scheme, ET prime takes a look at how similar schemes in Mexico, Ghana, and Sri Lanka have fared, and what India needs to
watch out for.
Priyanka Salve
3 Aug 2018
HEALTH PERSONNEL IN MEXICO DEMONSTRATE A PREVENTIVE HEALTH CHECK-UP GIVEN TO NEW MEMBERS OF THE COUNTRY'S UNIVERSAL HEALTH-INSURANCE SCHEME SEGURO POPULAR; THE WORLD BANK
You could call medical bills India’s public enemy #1.
In a report earlier this year, the Public Health Foundation of India (PHFI) found that healthcare expenses had pushed nearly 55 million Indians into poverty in 2011-12. That’s also because Indians pay nearly 70% of healthcare bills from their own pockets. Ideally this number should not cross 50%.
The current public and private insurance plans are inadequate as they largely service tertiary-care needs and cover only 36%-40% of the total population, comprising government employees and middle- or higher-income professionals.
The government’s panacea is the Ayushman Bharat scheme, which aims to provide health-insurance cover of up to INR5 lakh per family for secondary and tertiary hospitalisation to 100 million poor and their families, who are at the risk of falling into the poverty trap owing to backbreaking bills.
“Virtually in every country, some form of universal healthcare is provided,” says K Srinath Reddy, president of PHFI. “In Rwanda, there is a certain degree of co-payment, except for the poor, while South Korea has a mix of different schemes. Thailand has associated its scheme with increased life expectancy.”
With Ayushman Bharat aiming to cover 40% of the population, in addition to those already covered, India is closer than ever to achieving universal healthcare.
However, it isn’t the first in its peer group of low- to middle-income group countries to have a universal health scheme. ET Prime takes a look at the schemes in Mexico, Sri Lanka, and Ghana to find out how they have fared. Mexico — Popular Health Insurance
Introduced in 2003, the Mexican scheme Seguro Popular’s aim was to provide insurance cover to the poor and to workers in the informal sector. Just like India, Mexico already had other insurance schemes, mostly employer driven, such as those by the Mexican Social Security Institute and the Institute for Social Security and Services for State Workers. These schemes covered around 50% of the country’s population.
Each of these schemes has its own independent network of doctors, clinics, hospitals, pharmacies, and treatment centres.
The primary-healthcare network is at the heart of a referral-based system, as the professionals in this network restrict unnecessary hospitalisation in secondary- or tertiary-care hospitals, keeping costs under control. Private-sector hospitals also play a significant role.
Funds are allocated through service contracts to a network of both public and private healthcare providers on the basis of population needs. The government also rewards service providers that stand out for efficient and responsive care, according to a Lancet study in 2012.
“The government makes a per-capita payment to general practitioners, who are the first point of contact for patients,” says Sachin Bhokare, project lead for public health at health-tech and market-research firm IQVIA Asia Pacific.
However, private-sector insurance companies do not participate in the scheme, with the government channeling the insurance premiums through its non-profit institutions or public-sector insurance companies, adds Bhokare.
Mexico achieved universal healthcare coverage for its population in just nine years after launch, around 2012. Ghana — National Health Insurance Service
Launched in 2003, Ghana’s National Health Insurance Scheme (NHIS) has so far covered around 40% of its population but has an effective resource-pooling mechanism.
The government pays premiums for only the poorest, with the rest paying either full or part of the premium depending on income levels. The resources are pooled together to cross-subsidise district-level schemes, and are being used to build a single-purchaser system.
Before the NHIS was introduced, Ghanaians largely accessed healthcare by paying cash. But in the early 2000s, healthcare became a political issue, in the same way it has in India today, Bhokare says.
Under the National Health Insurance Scheme law, it was made mandatory for all Ghanaians to join the scheme.
“Like Mexico or Ghana, we should also look at a single-player system, if not at the central level then at state level. A single-player system is important for getting efficiency in purchasing both drugs and medical services,” says Reddy of PHFI.
“Even countries that have allowed various kinds of insurance programmes, including private-sector insurance companies, have provided a single-player system to control costs,” he adds. Sri Lanka — National Health Service
The island nation has one of the most enviable health report cards among all south-east Asian countries. However, unlike its neighbours, Sri Lanka started building a public healthcare system in the 1930s.
India, too, had started the Sri Lanka way, but the two countries are today at opposing ends of the spectrum. In Sri Lanka, primary care and state-owned hospitals form the backbone of the health system. In India, the tertiary system drives healthcare services, with the private-sector playing a dominant role.
“Ideally we should have gone the Sri Lankan way. We started off with a strong public health-delivery system and free care in government hospitals,” says Reddy. “But since allocation of resources was extraordinarily low in the public sector, [the system] dwindled. Services, especially in rural areas, became unavailable.”
While Sri Lanka’s free-for-all healthcare system is funded via budgetary allocations, India is relying on a strong insurance sector. But both countries have a common challenge — the rise of non-communicable diseases.
The island nation has a strong network of primary and secondary hospitals, but the tertiary system is underdeveloped, with many Indian private sector players looking for opportunities there.
Sri Lanka’s 40% out-of-pocket expenditure is largely due to expenses incurred by the rich and higher-income groups, who prefer to use the country’s 10% private-sector hospital network for outpatient service as it has shorter waiting times, according to a study by the World Bank this year. What India needs to put in place
In India too, due to economic growth over the last two decades, those who can afford it prefer to use private hospital services for better customer experience. While the private sector has expanded in India, says Bokhare, government hospitals also boast a utilisation rate of 100%.
However, lack of quality human resources and proper care are concerns for government hospitals.
A strong public-sector healthcare network is crucial for any universal health scheme to work. In India, the government needs to improve public-sector hospitals or else the whole system will become lopsided and the private sector will determine the prices in the scheme.
“The private sector is already fighting with the government, seeking better rates,” says Reddy. “If there is no counter-balancing mechanism from the government, it will become heavily dependent on the private sector.”
As the country prepares to roll out the world’s largest universal healthcare scheme, ET prime takes a look at how similar schemes in Mexico, Ghana, and Sri Lanka have fared, and what India needs to
watch out for.
Priyanka Salve
3 Aug 2018
HEALTH PERSONNEL IN MEXICO DEMONSTRATE A PREVENTIVE HEALTH CHECK-UP GIVEN TO NEW MEMBERS OF THE COUNTRY'S UNIVERSAL HEALTH-INSURANCE SCHEME SEGURO POPULAR; THE WORLD BANK
You could call medical bills India’s public enemy #1.
In a report earlier this year, the Public Health Foundation of India (PHFI) found that healthcare expenses had pushed nearly 55 million Indians into poverty in 2011-12. That’s also because Indians pay nearly 70% of healthcare bills from their own pockets. Ideally this number should not cross 50%.
The current public and private insurance plans are inadequate as they largely service tertiary-care needs and cover only 36%-40% of the total population, comprising government employees and middle- or higher-income professionals.
The government’s panacea is the Ayushman Bharat scheme, which aims to provide health-insurance cover of up to INR5 lakh per family for secondary and tertiary hospitalisation to 100 million poor and their families, who are at the risk of falling into the poverty trap owing to backbreaking bills.
“Virtually in every country, some form of universal healthcare is provided,” says K Srinath Reddy, president of PHFI. “In Rwanda, there is a certain degree of co-payment, except for the poor, while South Korea has a mix of different schemes. Thailand has associated its scheme with increased life expectancy.”
With Ayushman Bharat aiming to cover 40% of the population, in addition to those already covered, India is closer than ever to achieving universal healthcare.
However, it isn’t the first in its peer group of low- to middle-income group countries to have a universal health scheme. ET Prime takes a look at the schemes in Mexico, Sri Lanka, and Ghana to find out how they have fared. Mexico — Popular Health Insurance
Introduced in 2003, the Mexican scheme Seguro Popular’s aim was to provide insurance cover to the poor and to workers in the informal sector. Just like India, Mexico already had other insurance schemes, mostly employer driven, such as those by the Mexican Social Security Institute and the Institute for Social Security and Services for State Workers. These schemes covered around 50% of the country’s population.
Each of these schemes has its own independent network of doctors, clinics, hospitals, pharmacies, and treatment centres.
The primary-healthcare network is at the heart of a referral-based system, as the professionals in this network restrict unnecessary hospitalisation in secondary- or tertiary-care hospitals, keeping costs under control. Private-sector hospitals also play a significant role.
Funds are allocated through service contracts to a network of both public and private healthcare providers on the basis of population needs. The government also rewards service providers that stand out for efficient and responsive care, according to a Lancet study in 2012.
“The government makes a per-capita payment to general practitioners, who are the first point of contact for patients,” says Sachin Bhokare, project lead for public health at health-tech and market-research firm IQVIA Asia Pacific.
However, private-sector insurance companies do not participate in the scheme, with the government channeling the insurance premiums through its non-profit institutions or public-sector insurance companies, adds Bhokare.
Mexico achieved universal healthcare coverage for its population in just nine years after launch, around 2012. Ghana — National Health Insurance Service
Launched in 2003, Ghana’s National Health Insurance Scheme (NHIS) has so far covered around 40% of its population but has an effective resource-pooling mechanism.
The government pays premiums for only the poorest, with the rest paying either full or part of the premium depending on income levels. The resources are pooled together to cross-subsidise district-level schemes, and are being used to build a single-purchaser system.
Before the NHIS was introduced, Ghanaians largely accessed healthcare by paying cash. But in the early 2000s, healthcare became a political issue, in the same way it has in India today, Bhokare says.
Under the National Health Insurance Scheme law, it was made mandatory for all Ghanaians to join the scheme.
“Like Mexico or Ghana, we should also look at a single-player system, if not at the central level then at state level. A single-player system is important for getting efficiency in purchasing both drugs and medical services,” says Reddy of PHFI.
“Even countries that have allowed various kinds of insurance programmes, including private-sector insurance companies, have provided a single-player system to control costs,” he adds. Sri Lanka — National Health Service
The island nation has one of the most enviable health report cards among all south-east Asian countries. However, unlike its neighbours, Sri Lanka started building a public healthcare system in the 1930s.
India, too, had started the Sri Lanka way, but the two countries are today at opposing ends of the spectrum. In Sri Lanka, primary care and state-owned hospitals form the backbone of the health system. In India, the tertiary system drives healthcare services, with the private-sector playing a dominant role.
“Ideally we should have gone the Sri Lankan way. We started off with a strong public health-delivery system and free care in government hospitals,” says Reddy. “But since allocation of resources was extraordinarily low in the public sector, [the system] dwindled. Services, especially in rural areas, became unavailable.”
While Sri Lanka’s free-for-all healthcare system is funded via budgetary allocations, India is relying on a strong insurance sector. But both countries have a common challenge — the rise of non-communicable diseases.
The island nation has a strong network of primary and secondary hospitals, but the tertiary system is underdeveloped, with many Indian private sector players looking for opportunities there.
Sri Lanka’s 40% out-of-pocket expenditure is largely due to expenses incurred by the rich and higher-income groups, who prefer to use the country’s 10% private-sector hospital network for outpatient service as it has shorter waiting times, according to a study by the World Bank this year. What India needs to put in place
In India too, due to economic growth over the last two decades, those who can afford it prefer to use private hospital services for better customer experience. While the private sector has expanded in India, says Bokhare, government hospitals also boast a utilisation rate of 100%.
However, lack of quality human resources and proper care are concerns for government hospitals.
A strong public-sector healthcare network is crucial for any universal health scheme to work. In India, the government needs to improve public-sector hospitals or else the whole system will become lopsided and the private sector will determine the prices in the scheme.
“The private sector is already fighting with the government, seeking better rates,” says Reddy. “If there is no counter-balancing mechanism from the government, it will become heavily dependent on the private sector.”
No comments:
Post a Comment