India needs extensive universal health coverage policy: Experts

[PARIKRAMA]

India needs extensive universal health coverage policy: Experts
New Delhi, Jan 23, 2016, IANS:

India's universal health coverage policy needs to be extensive, considering the role of the states and Centre and lower than expected performance of healthcare services, experts opined here on Saturday at a conference on healthcare.

Given the challenges of the policy making environment in the country and the government's low spending on healthcare, the sector is not performing at the level it should have been to meet the demand of quality healthcare for India's growing population, said Rakesh Kumar, joint secretary, ministry of health and family welfare.

"18 percent rural population in the country has no access to healthcare," he said at the inauguration of 'Delivering on the Promise of Universal Health Coverage in India: Policy Options and Challenges'.

According to Kumar, the burden of non-communicable diseases in the country has increased. "Seventy percent of deaths in India will be caused by non-communicable diseases by 2020."

"Today's conference is the culmination of collaboration between Jindal Global University, Harvard Global Health Initiative and the Harvard School of Public Health to examine legal, policy and regulatory issues relating to the universal health coverage in India,"said C. Raj Kumar, professor and vice chancellor, O.P. Jindal Global University.

"The conference brought together academics, policy makers, doctors, lawyers, public health practioners and government representatives to discuss and debate a central issue of public policy, which is about the efforts to achieve universal health coverage in India," he added.

Explaining the impact of poor healthcare on the country, Ramanan Laxminarayan, professor, Public Health Foundation of India, said India is "very different from other countries" where "people may go into financial impoverishment because of high primary healthcare cost".

Laxminarayan said the quality of healthcare services is an important issue and non-harmful care must be ensured for the people. He highlighted the achievements of public sector undertakings like railways, saying that "public sector in India does deliver".

Laxminarayan said when public sector banks have an excellent level of accountability, why can't it be replicated in the healthcare sector.

Highlighting the state of medical education in India, Kesav Desiraju, former secretary, Department of Consumer Affairs and former secretary, Ministry of Health and Family Welfare, said the government has no interest in revising the curriculum of MBBS.

"The problem is much deeper than we think at the undergraduate level," he said. Desiraju said of the 416 medical colleges in the country, about 60 percent are in the private sector. "At macro level the numbers could be impressive but we are not getting the desired results."

"About 28 percent of the rural population and 20 percent of the urban population has absolutely no money to pay for healthcare services," the former secretary said.

Imrana Qadeer, senior fellow, Council for Social Development and former professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, gave a historical perspective of universal healthcare.

She said "diseases are rooted in poverty" and all healthcare plans in India focus mainly on technology while poverty reduction is never incorporated into them.

Analysing India's healthcare initiatives, Peter Berman, professor of the practice of global health systems and economics, Harvard T.H. Chan, School of Public Health and coordinator, India Health Partnership, said the National Rural Health Mission (NRHM) launched in 2005, which has now been renamed as NHM with spending cuts, was an important policy change for the healthcare sector in India.

"NRHM had set the target of spending 2-3 percent of the gross domestic product (GDP) on health by 2012. It had set specific targets for the Centre as well as states," he said.

Rajeev Malhotra, professor, Jindal School of Government and Public Policy and executive director, Centre for Development and Finance, said universal health coverage can be quantified. "Public and private sectors have mutually reinforcing role in providing healthcare in India," he said.

Stating that tracking the global impact of diseases is important, he said the breakout of Ebola upset all economic development projections in Africa.

Saying that the AYUSH programme of the government has not been tapped properly, he said: "The government has to take a call whether it wants to see itself as a player or a provider...Private sector's role needs to be strengthened in the value chain."

India needs extensive universal health coverage policy: Experts

@Abingdonboy @MilSpec @anant_s @Levina @ranjeet @nair @Spectre @[Bregs] @litefire @45'22' @scorpionx @Nilgiri @surya kiran @kaykay @Water Car Engineer @JanjaWeed @Parul @Abhijeet Sarkar @danish_vij @dadeechi @knight11 @ni8mare @sarjenprabhu @Brahmaputra Mail @zootinali

Solid topic..Views Pls.. This could be a good topic of discussion...
Pls feel free to tag more folks.. Lets get more views on this..

 

[45'22']

I dont think India should increase its GDP spending which is currently at around 4 percent on healthcare.
We just need to divert more funds towards public health care which is around 1 percent of gdp
Hope this comes true in the budget 16
Government to hike health care investment to 2.5% of GDP by 2020 | Business Standard Mobile Website
But we do need to improve the standards...
Was reading some article which mentioned Colombia despite having poor medical conditions managed to rank good in a WHO survey(ranked 22) because of some policy which allows poor people to pay less than the rich guys for the same treatment....
IMO India which ranked 119 needs to follow the same because our rural areas face the most in healthcare...

For urban areas...we need more doctors and more beds...MCI should increase the seats and state and central govt who work separately should collaborate for the hospitals.

 

[Bombermanx1]

Our Medicine was Nationalized as per Soviet unions thinking, what more do you want?
Universal health policy?
NHS or American system?

 

[Nilgiri]

We should go for a hybrid model of healthcare over time.

Tier 1: There should definitely be a basic free coverage for every citizen...concerning regular and frequent health related issues, checkups etc (where the cost benefit is very good to catch things early on/ prevention + reduced long term costs from reduced complexity of system at this level).

2nd tier would be for more expensive treatments that concern a list of health issues up to say 70 years old that can be fixed quite effectively with treatment/surgery/whatever. This must be done on an income based approach. Rich people are charged more based on wealth and income and a % of that premium goes toward medical research and financing for those less well off but can benefit the economy and society to a large degree with their life remaining.

Same tier goes for the medical tourism (though a CBA should be done to see at what level India can generate the most money from this by studying and determining the appropriate price elasticities and then suggesting them to all medical companies). The margins from this can then be plugged in as seen fit into the domestic tier and also medical research and other long term requirements.

Third tier are for old age related and cosmetic/low priority related things not covered by first two tiers that have very poor ROI to the economy as a whole. There should be minimal govt fiscal involvement in this and rather should be covered by the individuals themselves. For poor + middle class people, this should be part of a mandatory insurance program optimized for lowest burden on the country's overall fiscal resources. Extra private insurance is left for the indivdual to choose as he/she sees fit concerning income etc.

 

[anant_s]

just my 2 bits, but i guess focus must be on medical care during pregnancy and on new born including immunization along with nutrition.
a lot of kids are born with problems as basic care to expecting mothers is still elusive in many areas.
by ensuring above, a lot of problems can be solved as child grows to a healthy adult and IMHO this can actually reduce medical expenditure later in life for many dieseas that arise out of negligence during early days of life.

 

[Brahmaputra Mail]

I cannot substantiate my claims with facts and figures. It's just my general observation.

Healthcare and education are very important part of human resource development. A country that achieves to impart good education to its population and provide quality healthcare for all will definitely prosper. India currently suffers from inefficiency in these two field. A good health is necessary for a person to realise his full potential. A weak person's output will definitely be lesser than a healthy person's output. But to remain healthy one must get access to good food, good environment (that includes access to good sanitation and good drinking water) and good healthcare.

When it comes to healthcare I speak of quality healthcare. In India sadly we have many highs and lows when it comes to healthcare. At one end we were able to achieve a polio-free India, but on the other end some of our people still suffer from many preventable diseases, like dengue, HIV/AIDS and malaria. The lack of awareness can be considered as one reason. From many other reasons, one includes lack of proper and timely diagnosis. In many rural and urban areas by the time a communicable disease is diagnosed, it already served its purpose of multiplying to other hosts. Should we say this is because of lack of education? May be or may be not ! Look at Mizoram, a state in North-Eastern India that has second highest literacy rate in India, after Kerala. Despite that fact it still has one of the largest cases of HIV infections. This is classic contradiction to claims that literacy alone can prevent diseases. Because the quality of education in India is itself under a big question mark. It barely serves the purpose of general awareness.

Awareness is the key. If people are aware of their surroundings, about the diseases our surroundings can cause, symptoms of the disease and cure for it, there will be significant reduction in numbers of hospital patients. Another type of awareness is rationality of patients. Most of the time patients misuse the easy over-the-counter availability of anti-biotics. The increased consumption of anti-biotics beyond the prescription limits have proved to be counter-productive. The diseases have evolved themselves and built a resistance against these anti-biotics due to increased uncontrolled consumption of anti-biotics. Also patients often tend to overdo many medicines, besides anti-biotics in order to avoid visiting doctor again and again. A repeatative visit to doctor for diseases that occur many a times throughout life surmounts the medical bills. A visiting fee itself costs around ₹ 300/- on minimum in India in private clinics. Let's face it ,government cannot reach to people living in every nook and corner of India. That's where private clinics serve the purpose. A population of 1.3 billion certainly has its disadvantage !

As for the overall healthcare situation in India, certainly both central and state governments need to revamp its present infrastructure. While at a time when private medical hospitals are flourishing in India, attending to patients coming from not only India, but advanced countries like USA and UK, our govt. hospitals can be considered to be somewhat in a quagmire. Irony is even our lawmakers would prefer a private hospital over a govt. hospital. Although I admit certain hospitals like AIIMS can prove this statemant as false. But in all possibilities we can say that even a common person, who has a modest salary of ₹ 3,00,000 lakh per annum or above will prefer to have himself treated in private hospitals. Treatment costs are certainly low in govt hospitals compared to private ones. But the govt hospitals need to ramp up its facilities, particularly the equipments that helps in early diagnosis of life threatening diseases like cancer.

End note:

Education and Healthcare are twin-engines of India's growth. If we concentrate on these two, certainly we will have a much faster per capita development.

 

[scorpionx]

Before committing ourselves to Universal Health Coverage, we must get out of the delusion that a poor health care system can improve through massive privatization of healthcare and insurance policies only. Public health centers in most part of India are in abysmally precarious state, devoid of basic facilities like electricity, weighing machines, primary medicines etc. Many of these health centers remains closed and staff absenteeism is a regular affair in general.

What needs to be done is to increase the geographical density of these centers, provide them with more doctors, nurses and technical staffs with basic diagnosis equipment. Southern states like Tamilnadu and Kerala have achieved tremendous success by increasing public involvement in healthcare and there is no reason to believe that rest of India can not emulate these two experiences.

 

[PARIKRAMA]

Some of my personal thoughts..
Firstly, in spite of multiple systemic flaw, the biggest flaw comes from the fact that the MBBS system in India is largely dominated by private college systems. The direct entry or the capitation fee route in turn creates a very high cost of pursuing medicine course in MBBS at UG level.

The result is that a certain large population of new passout doctors like to start working in a private sector in a private hospital or in positions and places more closer to urban centers in order to ensure they make adequate money to have some returns to their "investments". We need either a cap on such high fees or more public education colleges/institutes. The fee racket has to be stopped somehow.

The second major issue is the quality of health care centers especially public centers need an overall improvement at a national levels. Most of our rural centers and even in semi urban centers do not have
1. Proper basic setup/infra
2. Systems
3. Hygienic environment
4. Requisite number of Manpower including Doctors
5. Grants/ Aid released are gobbled up by the people in the system and finally only peanuts actually reach the centers

The third major problem is the issue of misinformation and mis selling. The most common diseases traversing through the whole country is the communicable and infectious disease like for example Water borne diseases, Typhoid, TB etc etc. Holistically speaking sanitation and hygiene has made a huge dent and is working as a catalyst against mankind effort to take on diseases. Coupled with the fact that most less informed common people in rural and semi urban places are duped in going for four major steps of vicious cycle
1. Too many medical tests where for every small thing the common man is asked to test almost everything possible to "determine" the cause
2. The dosage and course of medicines being much longer. For example if a prescription can be for 3-5 days, the modus operandi is 7-10 days.
3. The follow up schedule in a weeks time where its said with the obvious dialogue - "the expected progress are a bit slow.. I think the body's natural resistance to the medication is slowing the recovery. We will have to do some more tests and then we will change the medicines for better response."
4. Go back to Step 1

This essentially is the killer mode of making money with almost very limited control and accountability.

The fourth major issue now is the lifestyle issues of particularly the service people who nowadays are so much under pressure, pollution and a very unbalanced working and living life that they are bound to suffer from lifestyle diseases. Coupled with our food intake where we have moved away from high quality low costing true carbs, proteins and fats to highly processed foods, take away and high calorie binge eating. Especially bcz our food timings have been highly improper. The result is the systemic increase in lifestyle diseases like hypertension, obesity, cardio issues or even cancer from active and passive smoking.etc etc. This avenue must be well researched and all people should be imparted awareness education on how to balance their lives and decrease the risk of lifestyle disease. This is going to be a massive problem as we see lifestyle diseases increasing in rural places.

Fifth is the increase of two specific types of disease - respiratory and STD's at urban, semi urban and rural sides. A complete awareness campaign must be initiated to make people understand the risks and how their actions are causing harm to the entire system of people.

One good thing is in India generic medicines are still cheap and the government control over basic price have helped at least curb the cost of medication. But as explained above the ways and means to fool and dupe the system even now exists. Thus, efforts must be made to improve that.

Few suggestions
1. Increasing the average number of public health care centers per districts
2. Each of these centers financial position being audited by local audit firms
3. On site visit and review of services/infrastructure to be done every year by team to see if they are meeting nationally defined requirements
4. Awareness of symptoms, medication and process via mediums like Radio, TV, Newspapers should be increased.
5. Solid non breakable laws for unlicensed and unqualified fake doctors, compounders, nurses, practitioners, pharmacists etc. The cheating syndicate has to stop
6. A system to increase accountability must be implemented.

Hope others can add and dissect what i had written above..

 

[dadeechi]

India needs extensive universal health coverage policy: Experts
New Delhi, Jan 23, 2016, IANS:

India's universal health coverage policy needs to be extensive, considering the role of the states and Centre and lower than expected performance of healthcare services, experts opined here on Saturday at a conference on healthcare.

Given the challenges of the policy making environment in the country and the government's low spending on healthcare, the sector is not performing at the level it should have been to meet the demand of quality healthcare for India's growing population, said Rakesh Kumar, joint secretary, ministry of health and family welfare.

"18 percent rural population in the country has no access to healthcare," he said at the inauguration of 'Delivering on the Promise of Universal Health Coverage in India: Policy Options and Challenges'.

According to Kumar, the burden of non-communicable diseases in the country has increased. "Seventy percent of deaths in India will be caused by non-communicable diseases by 2020."

"Today's conference is the culmination of collaboration between Jindal Global University, Harvard Global Health Initiative and the Harvard School of Public Health to examine legal, policy and regulatory issues relating to the universal health coverage in India,"said C. Raj Kumar, professor and vice chancellor, O.P. Jindal Global University.

"The conference brought together academics, policy makers, doctors, lawyers, public health practioners and government representatives to discuss and debate a central issue of public policy, which is about the efforts to achieve universal health coverage in India," he added.

Explaining the impact of poor healthcare on the country, Ramanan Laxminarayan, professor, Public Health Foundation of India, said India is "very different from other countries" where "people may go into financial impoverishment because of high primary healthcare cost".

Laxminarayan said the quality of healthcare services is an important issue and non-harmful care must be ensured for the people. He highlighted the achievements of public sector undertakings like railways, saying that "public sector in India does deliver".

Laxminarayan said when public sector banks have an excellent level of accountability, why can't it be replicated in the healthcare sector.

Highlighting the state of medical education in India, Kesav Desiraju, former secretary, Department of Consumer Affairs and former secretary, Ministry of Health and Family Welfare, said the government has no interest in revising the curriculum of MBBS.

"The problem is much deeper than we think at the undergraduate level," he said. Desiraju said of the 416 medical colleges in the country, about 60 percent are in the private sector. "At macro level the numbers could be impressive but we are not getting the desired results."

"About 28 percent of the rural population and 20 percent of the urban population has absolutely no money to pay for healthcare services," the former secretary said.

Imrana Qadeer, senior fellow, Council for Social Development and former professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, gave a historical perspective of universal healthcare.

She said "diseases are rooted in poverty" and all healthcare plans in India focus mainly on technology while poverty reduction is never incorporated into them.

Analysing India's healthcare initiatives, Peter Berman, professor of the practice of global health systems and economics, Harvard T.H. Chan, School of Public Health and coordinator, India Health Partnership, said the National Rural Health Mission (NRHM) launched in 2005, which has now been renamed as NHM with spending cuts, was an important policy change for the healthcare sector in India.

"NRHM had set the target of spending 2-3 percent of the gross domestic product (GDP) on health by 2012. It had set specific targets for the Centre as well as states," he said.

Rajeev Malhotra, professor, Jindal School of Government and Public Policy and executive director, Centre for Development and Finance, said universal health coverage can be quantified. "Public and private sectors have mutually reinforcing role in providing healthcare in India," he said.

Stating that tracking the global impact of diseases is important, he said the breakout of Ebola upset all economic development projections in Africa.

Saying that the AYUSH programme of the government has not been tapped properly, he said: "The government has to take a call whether it wants to see itself as a player or a provider...Private sector's role needs to be strengthened in the value chain."

India needs extensive universal health coverage policy: Experts

@Abingdonboy @MilSpec @anant_s @Levina @ranjeet @nair @Spectre @[Bregs] @litefire @45'22' @scorpionx @Nilgiri @surya kiran @kaykay @Water Car Engineer @JanjaWeed @Parul @Abhijeet Sarkar @danish_vij @dadeechi @knight11 @ni8mare @sarjenprabhu @Brahmaputra Mail @zootinali

Solid topic..Views Pls.. This could be a good topic of discussion...
Pls feel free to tag more folks.. Lets get more views on this..

My 2 cents on this topic. Rather than focusing on the symptoms and treatment of the unhealthy, India should focus on the root causes and their solutions for long term sustainable results


1) Convert mid-day meal program to three-meal-per-day program at schools and serve clean, healthy & nutritious food (milk, Leafy veggies and Lentils)

2) Comprehensive ban on the manufacture and sale of the following

Alcohol
Soft drinks
Tobacco
Refined (White) flours
Refined Sugar (white Sugars)
Hydrogenated Oils and dalda
Polished rice, lentils and seeds
Homogenized, HTST & Ultra-Pasteurized milk (Limit to Raw and Vat Pasteurization only)
Chemical and solvent extraction of Oils (Limit to hydraulic pressed)


3) Implement Organic and rotating crop farming techniques to increase the nutritional value of the agricultural output (Ban the use of Chemicals and pesticides in agriculture instead use Organic manures)

4) Implement cleanliness, yoga and physical education in schools

5) Implement strict industrial waste disposal management policies to limit the impact on land, air & water resources

6) Ban use of plastics and harmful metals in food packaging industry

7) Ban all types of artifical and chemical additives (Flavors, Colors, fillers and Preservatives) in food industry

8) Implement and provide safe and mineral rich drinking water to everyone

9) Ban plastic, harmful metals (aluminum, Lead) and Non-stick cooking utensils (Use Stainless Steel, Copper, cast Iron instead)

10) Ban use of artificial growth hormones in meat and dairy industry

11) Implement strict cleanliness and safety policies for Restaurant industry

 

[zootinali]

Some of my personal thoughts..
Firstly, in spite of multiple systemic flaw, the biggest flaw comes from the fact that the MBBS system in India is largely dominated by private college systems. The direct entry or the capitation fee route in turn creates a very high cost of pursuing medicine course in MBBS at UG level.

The result is that a certain large population of new passout doctors like to start working in a private sector in a private hospital or in positions and places more closer to urban centers in order to ensure they make adequate money to have some returns to their "investments". We need either a cap on such high fees or more public education colleges/institutes. The fee racket has to be stopped somehow.

The second major issue is the quality of health care centers especially public centers need an overall improvement at a national levels. Most of our rural centers and even in semi urban centers do not have
1. Proper basic setup/infra
2. Systems
3. Hygienic environment
4. Requisite number of Manpower including Doctors
5. Grants/ Aid released are gobbled up by the people in the system and finally only peanuts actually reach the centers

The third major problem is the issue of misinformation and mis selling. The most common diseases traversing through the whole country is the communicable and infectious disease like for example Water borne diseases, Typhoid, TB etc etc. Holistically speaking sanitation and hygiene has made a huge dent and is working as a catalyst against mankind effort to take on diseases. Coupled with the fact that most less informed common people in rural and semi urban places are duped in going for four major steps of vicious cycle
1. Too many medical tests where for every small thing the common man is asked to test almost everything possible to "determine" the cause
2. The dosage and course of medicines being much longer. For example if a prescription can be for 3-5 days, the modus operandi is 7-10 days.
3. The follow up schedule in a weeks time where its said with the obvious dialogue - "the expected progress are a bit slow.. I think the body's natural resistance to the medication is slowing the recovery. We will have to do some more tests and then we will change the medicines for better response."
4. Go back to Step 1

This essentially is the killer mode of making money with almost very limited control and accountability.

The fourth major issue now is the lifestyle issues of particularly the service people who nowadays are so much under pressure, pollution and a very unbalanced working and living life that they are bound to suffer from lifestyle diseases. Coupled with our food intake where we have moved away from high quality low costing true carbs, proteins and fats to highly processed foods, take away and high calorie binge eating. Especially bcz our food timings have been highly improper. The result is the systemic increase in lifestyle diseases like hypertension, obesity, cardio issues or even cancer from active and passive smoking.etc etc. This avenue must be well researched and all people should be imparted awareness education on how to balance their lives and decrease the risk of lifestyle disease. This is going to be a massive problem as we see lifestyle diseases increasing in rural places.

Fifth is the increase of two specific types of disease - respiratory and STD's at urban, semi urban and rural sides. A complete awareness campaign must be initiated to make people understand the risks and how their actions are causing harm to the entire system of people.

One good thing is in India generic medicines are still cheap and the government control over basic price have helped at least curb the cost of medication. But as explained above the ways and means to fool and dupe the system even now exists. Thus, efforts must be made to improve that.

Few suggestions
1. Increasing the average number of public health care centers per districts
2. Each of these centers financial position being audited by local audit firms
3. On site visit and review of services/infrastructure to be done every year by team to see if they are meeting nationally defined requirements
4. Awareness of symptoms, medication and process via mediums like Radio, TV, Newspapers should be increased.
5. Solid non breakable laws for unlicensed and unqualified fake doctors, compounders, nurses, practitioners, pharmacists etc. The cheating syndicate has to stop
6. A system to increase accountability must be implemented.

Hope others can add and dissect what i had written above..

I would add
7. Proper and continued training of all health workers , to treat all patient with compassion and dignified manner.
8. Compulsory specialization (post graduation) for all M.B.B.S doctors.
9. Expansion of infrastructure of all CHCs,FRU and PHCs to handle complicated cases to decrease the burden on tertiary centers.
10. Increase the salary and other incentives for all govt. doctors .

"3. On site visit and review of services/infrastructure to be done every year by team to see if they are meeting nationally defined requirements" This alone will probably weed out half of the problems of our ailing health care system.