New Delhi: Public health experts and thought leaders including policy makers, academicians, economists, patient groups, hospital administrators, public and private insurance companies gathered on August 17, 2016 in the capital to discuss the need for a multi-payer approach to ensure quality health care for all.
With healthcare financing emerging as a major concern, the objective of the conference was to understand how household out-of- pocket expenditures can be contained, review alternative mechanisms and plan ahead with potential options. An analysis of the strengths and weaknesses of existing and alternative financing models was also underscored in the discussions.
India has a high reliance on out of pocket expenditure on health. Recent NSSO survey reveals that private out-of-pocket expenditures on health is dominant with about 70 percent of all health care spending in the country. However, coverage under private insurance is very narrow and is limited mostly to major urban area.
It is worth noting that the out of pocket expenditure per ailing person for hospitalized and non hospitalised treatment is one of the highest in case of cancer and heart ailments. Proportion of expenditure on diagnostics is relatively much higher for cancer and heart strokes. Experts suggested that the policy design for ensuring universal health coverage should be based on prevention, diagnosis, care, treatment and rehabilitation of NCDs. This requires a multi pronged approach which goes beyond curing an ailment to identifying more cost effective primary interventions.
According to Dr Indrani Gupta, Professor and Head, Health Policy Research Unit, Institute of Economic Growth, “Financing of NCDs and injuries (NCDI) must be seen in the overall context of financing of health, especially universal health coverage. An essential health package which includes prevention and treatment of NCDI would be the right approach. The responsibility for implementing such a package lies with the government and it will have to raise sufficient finances for this. However, complementary and supplementary financing for especially the non below poverty line population through other instruments like insurance can be explored but only with adequate regulation, monitoring and oversight”.
Dr Kenneth Thorpe, Chairman, Partnership to Fight Chronic Disease (PFCD), said that, “NCDs result in lower productivity and lost economic output. Therefore, investing in prevention, primary care and coordinated care will improve health and increase economic growth. Government needs to create a roadmap for educating individuals about lifestyle disorders increasingly impacting health. Investing in health and education improves health outcomes and life expectancy. Each 10 percent improvement in life expectancy at birth is associated with a 0.3 to 0.4 percentage point increase in GDP.”
- Reallocation of resources to improve efficiency in spending and to enhance outputs/ outcomes
- Review of the bottlenecks for underutilization of budgets is another area for augmenting resources.
- Assessing the capacities of households to move towards financial pooling for health care. Households are already paying larger share of their incomes for health care. Any additional burden due to financial pooling may dissuade households
- Adoption of the pre-pooling option, citing evidence and case studies from other countries that have successfully implemented this option for better healthcare coverage
- Options such as performance based/ results based financing to maximize outputs/ outcomes may be explored. Currently few schemes such as JSY (Janani Suraksha Yojna) are functioning under similar principles as performance based financing.
Present at the conference V Selvaraju, Secretary, Indian Health Economics and Policy Association (IHEPA) said that, “With health encapsulated in the growth story of India, it is imperative for the central and state governments to prioritize NCDs and work in a more coordinated manner. More effective rationalization of resources to better leverage health funding is required. Additionally, new ways of raising resources as well as service delivery mechanism may be an option to expand services.”
According to Roopali Goyanka, Associate Professor, Department of Economics, Indraprastha College for Women, University of Delhi, “The health sector needs to pay a greater tension to primary intervention and prevention of all chronic diseases. The health workers at the primary level need to be trained to have an eye on the symptoms of these diseases”.
Investment in NCDs should be considered as a poverty alleviation and development initiative because such investments generate significant national returns by reducing pre-mature mortality, increase in productive years of life, and reduced costs of managing chronic illnesses.