Health Care Sector in India: Some Key Issues

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Health Care Sector in India Some Key Issues

• VR Muraleedharan
• Dept of Humanities and Social Sciences
• Indian Institute of Technology Madras
• vrm_at_iitm.ac.in

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Outline

• The Fundamental challenge in public finance
• Basic Features of Indian Health Care Sector
• Status of Health
• Access to health care (use of health care
  services)
• Cost of health care
• Distribution of Benefits of Public Spending
• Key Policy Questions

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Fundamental Challenge in Public Finance

• How much should the government spend for health
  care? role of government in financing and
  providing health care to the people
• How should the benefits of public spending (on
  healthcare) should be distributed across various
  socio-economic groups? Who deserves how of much
  of financial support for health care?
• Fundamental principle A rupee spent on one
  person is a rupee denied to another person.

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Objectives of Healthcare System

• Improve health status
• Provide protection against financial risks
  arising from illnesses poverty reduction
  strategy
• Institute mechanisms to meet legitimate
  expectations of patients

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Health Status Indicators
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Use of Health Care Services

• Dependence on Public and Private Providers

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Costs of Health Care

• Financial Burden of Ill-health

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Two major Health Policy Challenges

• Reduce inequity in health status
• Social and economic strata
• Reduce the impoverishing effects of catastrophic
  health expenditures

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Income inequality and health statusRecent
Evidence

• Increase in Income, Education, Health Personnel
  exert a statistically significant negative impact
  on health status (IMR)
• But
• Increases in income inequality cause health
  status (IMR) to increase.
• (evidence holds good for both high income and low
  income countries)

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Utilization of Inpatient Days in Public System
TN and Orissa (NSS 60th Round 2004)
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Utilization of Maternity Services in Public
System TN and Orissa (NSSO 60th Round, 2004)
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How Much Do Governments Spend on Health
Care?AndHow much Should Government
Spend?
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Trends in Per-Capita Public Expenditure

• Rs. 64 (1991-92)
• Rs.184 (2001-02)
• Rs.214 (2003-04)

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Evidently, governments spending spent is LOW
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Policy Options

• How should the health care system be organized?
• (Financing and Provision)
• Public vs Pvt sector
• PPP strategy?

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PPP or PPM? Some Common Questions

• Why PPP?
• How to assess whether PPP works well?
• Conditions for PPPs success?
• What is PPP?

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Why PPP? Some Familiar Answers

• Private sector already widely present utilize
  their resources for improving public health
• Better delivery system better geographical
  access
• Lack of funds in public sector to expand will
  outsourcing reduce public expenditure?
• Peoples dependence on private sector and better
  satisfaction.

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Nature of participation examples

• Financial
• Non-Philanthropic
• Joint ventures
• Subsidies and concessions to private sector
• Philanthropic Contributions
• BGF
• Local Industrialists contributions (TN)
• Drugs (from MNCs case of DEC for Filariasis)

• Non-financial
• Philanthropic
• In-kind contributions
• Community labour for construction of PHC (TN)
• Non-philanthropic
• Health Camps by corporate hospitals

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Forms of participation examples

• Curative /Diagnostic Services
• Hiring clinical staff (OBGYN/Anesthetists/
  medical officers)
• Blindness Control
• Hiring nursing staff
• Contracting-out of laboratory work

• Preventive /Promotive
• Services
• HIV-AIDS role of NGOS
• TB control role of NGOs, Hospitals, Private
  practitioners, Microscopy centres

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Forms of participation examples

• Supportive services
• Ambulance
• Catering
• Security
• Laundering

• Rehabilitative
• Mental health programme?
• Reconstruction of cleft formation (BGF)

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Policy Justifications for PPP

• PPP is not an end in itself.
• PPP should eventually
• Reduce cost of care
• Improve access to care
• Improve quality of care
• Reduce inequality in health status (geographic,
  gender, socio-economic groups)

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Thank You