The prerequisites for an ideal health financing system in India are improved health indicators, reduced burden of catastrophic expenditure and improved equity by applying some of the principles of the health economics. The discussion on Sustainable Health Financing Systems/ Health Economics by Prof Dayashankar Maurya, Chairperson, Healthcare Management & International Relations, TA Pai Institute of Management with an eminent panel comprising, Gajendra Kumar, Advisor, Ministry of Railways, Government of India; Dr RK Srivastava, Sr Advisor, Public Health and Innovation, Wadhwani Initiative for Sustainable Healthcare (WISH) Foundation; and Dr Payal Laad, Assistant Professor of Community Medicine, Public Health at Lokmanya Tilak Medical College and Hospital revolved around analysing these aspects.
Prof Maurya highlighted India’s overall healthcare expenditure being 4.7 per cent of the GDP which is at par with many other countries, yet the healthcare outcomes are far less. He elaborated on the role of financing mechanisms in determining incentives to players, providers as well as insurers. “There are various factors that are currently impacting financia;l mechanisms such as shifting disease burden, rapid aging population, medical inflation rate along with technological growth which will increase cost of healthcare in the future thus making it difficult to create a sustainable healthcare system. There is a need to make a shift from curative to preventive healthcare.”
He posed a question to Dr Srivastava on how India should move forward to deliver value for health? He suggested to reserve a percentage of budget for preventive, curative and rehabilitative services. He expounded on healthcare expenditure distribution variables wherein the public sector holds around 1.14 per cent and invests largely in the primary care, whereas private sector invests mostly on secondary and tertiary. “The larger chunk requires primary health but minimum resources are allocated towards it, therefore the end users suffer. Increasing public health expenditure, empowering healthcare experts to improve planning will help better the healthcare scenario.”
Continuing with the discussion, Dr Laad referred to medical colleges being the think tank of the country yet they are not utilised to the fullest. She gives a few measures to be considered such as involving beneficiaries’ opinion in policy making, testing schemes on computer assisted epidemiological models, monitoring, evaluating and revamping current processes. “As our age of survival is increasing, so is our age of retirement” she exclaimed. Further she raised an integral point for a need to delibrate on the budgetary allocation of continuum of care, hospices and palliative care.
Taking forward the discussion Dr Srivastava added that there is a requirement to change provider’s behaviour to produce an evidence-based, rightly financed and cost effective system. He mentioned that there is an urgent need for faculty development programmes. He suggested that the continuum of care should emerge by a robust financial evidence gathering mechanism.
He reflected upon how an integrated care system can be created through the utilisation of technology as healthcare service users can be linked through online records. He highlighted the importance of digitalisation, partnerships with start ups and devising new solutions with the help of technology.
The panel further discussed on the administrative integration which involves various ministries and their link with delivering value – based healthcare. Gajendra Kumar pointed out that preventive and promotional interventions is the need of the hour. He suggested that there needs to be a synergy among the public and the private healthcare providers.
Taking a few learnings from Bangladesh’s health financing system, Dr Srivastava explained that there is an organised consumer movement with a strong cooperative insurance system which the government promotes which can be adopted by India.
Dr Laad adds a few experiments which can be applied forcreating a sustainable financing model. She recommended for a community – based health insurance wherein Mutual Health Organisations (MHO) are created and NGOs work towards the betterment of the community. She mentioned about NHM’s Panchayati Raj Institutions have played a vital role and could me more acceptable.
Prof Maurya concluded the sessions with various learning such as a need to use different financing modes and performing experiments to add innovations. He added that including technology is essential to create an unfragmented system.