The Lok Satta Party today unveiled a unique program of public-private partnership to ensure universal and free hospitalized care in Andhra Pradesh.
The program, estimated to cost Rs.2500 crore a year, guarantees hospital care to every citizen as a matter of right irrespective of his or her income status. Unlike other programs, it is not limited to those below the poverty line.
Dr. Jayaprakash Narayan, Lok Satta Party Coordinator, who had played a seminal role in formulating the national health policy and creating the National Rural Health Mission, told a media meet today that the Lok Satta Party's innovative program would put an end to the dismal health care situation. The concept brochure was released by Party State Working Committee member Mrs. G. Pratibha Rao.
At present, Dr. JP pointed out, hospitalized health care accounted for more than half (58%) of Indians' total annual expenditure on healthcare. As a consequence, more than 40 per cent of those hospitalized borrow money or sell assets to cover expenses. At least one quarter of hospitalized Indians fall below poverty line because of hospital expenses.
The following are the highlights of the Lok Satta proposal:
1. The patients will be given an option to get admitted in a hospital of their choice and the money will 'follow the patient'
2. Every patient will be given a health card and the utilization of services will be recorded on patient cards. At the end of the month, hospitals (public or private) will claim reimbursements from the Government on the basis of services provided to in-patients
3. Hospitals will be funded only by way of reimbursement of costs for services rendered. The coverage of private hospitals will exclude out-patient care
4. To effectively combat the menace of corruption, the proposal includes creation of institutions such as a District Health Fund and a District Ombudsman.
Dr. JP said that the Lok Satta proposal seeks to involve both Government hospitals and private facilities equally in providing quality care at Government cost. In addition, private practitioners can utilize government hospitals for practice, and claim reimbursements for the services rendered.
Dr. JP clarified that that a patient need not pay any deposit or a premium since it is not an insurance program. Every individual will be entitled for free health care whenever he/she is admitted to hospital. Such an approach is based on the premise that people living in this country are entitled for free health care as citizens paying taxes.
Once an individual receives a Health Card, s/he will not have to visit any Government office. All that an individual has to do is to carry the health card with him/her when getting admitted in a hospital. The hospital authorities (public or private) will claim reimbursements at the end of every month. All medical expenses of in-patients will be covered by the program. These include in-patient charges, medication, diagnostic tests and surgeries. In case of public hospitals, out-patient care will be included.
This program is not targeted at specific diseases. All common aliments will be covered. Rare diseases involving high cost care will be separately dealt with through a tertiary care program.
Dr. JP explained that the Andhra Pradesh Government's 'Aarogyasri' addresses only a few rare diseases that people are vulnerable to, which is a small portion of the disease burden. It targets people suffering from a limited number of illnesses like those affecting heart, brain and kidney or cancer or but not ordinary ailments, which account for most of the disease burden. It ignores maternity care, infectious diseases, routine surgeries and general ailments, and non-surgical interventions.
As of September 1, 2007, only 3841 people had undergone surgical procedures under AarogyaSri, while 60 lakh people are sliding below the poverty line every year in the State because of health care costs.
'Aarogyasri' benefited only corporate hospitals, as 95% of the cases were treated in big corporate hospitals. Most of the private practitioners and nursing homes providing low-cost, good-quality care are not utilized. Instead, expensive hospitals are involved in providing high cost care for a few selective aliments. Andhra Pradesh has an estimated 40,000 well-trained private allopathic practitioners.
The Lok Satta proposal seeks to mobilize all resources available in the State to ensure that every one gets quality health care at Government cost. A strong preventive primary health care programme, and high-quality health infrastructure in public sector will be the foundation of this programme of universal healthcare. Primary health centres will be strengthened and brought under local government control. A community Hospital of 50 beds will be built for every 1,00,000 population. (At present we only have one for every 4,00,000). All district and Teaching Hospitals will be improved substantially. Dr. JP gave a call for a debate on universal, affordal healthcare. He appealed all stake-holders - doctors, civil society and people of all sections -to join the struggle to build a viable universal healthcare programme.
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Dear Dr JP
ReplyDeleteThe existing health delivery system is indeed appalling. It is heartening to know that Loksatta has taken stance on heath related issues. The proposed plans, for health acre delivery of health care are good. Unless drastic reforms are also introduced, there is a huge risk that proposed health care delivery system will go down the same path, as our ration shops.
I will point in the following paragraph, the possible drawbacks of the proposed system.
I feel the proposed system is based on huge assumption that all doctors/ private hospitals are angles. The proposed system has so many loop holes that, it will be exploited to core.
Let us consider a hypothetical scenario. Say a Gentlemen x, visits a doctor. Doctor advices that this gentlemen will need x days of admission, with x number of investigation. Let�s assume that this gentleman underwent an operation as part of his treatment.
This simple scenario poses lots of questions
1) How do we establish, that this gentlemen x had a genuine problem?
2) How do we establish, that this gentleman admission was necessary?
3) How do we establish, that this gentlemen tests were necessary or whether the operation was necessary at all?
In the proposed system, there is a strong incentive for the doctors/hospitals, to over investigate &to over treat, irrespective of the needs of the patient. The net result - patient lives/health at risk. Not to mention about public money filling up private hospital coffers with this proposed system.
I am sure you are pretty much aware, doling out money alone will not fix the system. Drastic REFORMS -.is the mantra.
Current system of doctor�s regulation doctors has to be relooked, & reforms brought to suit 21st century.
One way to shield the proposed system from being misused is to audit, secondary care provision. For this to happen the secondary care should be delivered at fixed government approved centres & no where else. There should be a fixed, predetermined, charge for utilising the facility. With multiple centres opearating, there will be healthy competition among the centres to provide the best services. Auditing will ensure that the standard of care is uniform across the spectrum.
Currently primary care & preventative health are synonymous. It might be appropriate for western setting, as the disease profile is completely different. In our setting it is best to separate both the departments so that they can function efficiently. For example, currently PHC doctors are leading many preventive programmes like malaria prevention programme etc. With so much of administrative work /targets involved , PATIENT CARE will take back burner. More over there is incentive to fudge the figures to achieve the target.
Hope my views were useful
Dr Prabhakar Reddy
UK
Well written article.
ReplyDelete