“Given the key healthcare challenges and financing and service delivery mechanisms in India, I am of the view that to achieve universal and affordable health coverage, reform in health financing holds the key”, said Mr Lov Verma, Secretary-Health, Ministry of Health and Family Welfare, at the 8th Health Insurance Summit with “Leveraging the Power of a Billion People” as the theme. The Summit was organized by the Confederation of Indian Industry in New Delhi on August 27, 2014.
India would need to step up the level of public spending on health to a minimum of 2.5% of GDP by 2017 to provide a reasonable package of healthcare services to its citizens. Roughly 70% of this has to be on comprehensive primary care as good primary healthcare minimizes hospitalization/tertiary care. Insurance, he said, deals best with hospitalization and costlier and rarer events and tertiary care is most suitable for universal health insurance. The dream of leveraging the power of a billion people, he said, assumes significance only when the coverage is universal with no adverse selection, he elaborated.
Elaborating on the challenges faced by India, Mr Verma stated that India, with 60% Out-of-Pocket-Expenditure (OOPE) has one of the highest OOPE, which is a major cause of impoverishment of the country’s population. To address this challenge of providing financial protection, different countries have adopted different approaches – either strengthening supply side, or demand side measures – while India traditionally followed a tax-based supply side strengthening process. Insurance was introduced much later, but today health insurance is a demand-side financing tool that is gaining popularity across the world, he said.
He said that it is estimated that 400 million people were covered in 2012, and according to a World Bank report, health insurance coverage in India is expected to cross 630 million people or 50% of the population by 2015. He emphasized that innovative and cost effective solutions is the key to achieving the aspirations of our billion people and improve quality, efficiency and accountability of public and private health systems for the large and common benefit of the people.
Earlier, setting the context for the conference, Mr Annaswamy Vaidheesh, Chairman, Sub-committee on Accessibility: Health Insurance & vice President, Corporate Government Affairs and Policies, Asia Pacific, Johnson & Johnson, said that a multi-stakeholder approach is the way forward to address standards and guidelines for the Health Insurance industry in India. Health insurance is an evolving, dynamic and challenging vertical and issues such as health/medical inflation, misuse of funds, frauds, lack of awareness and the changing disease burden need to be addressed. To actualize the power of a billion people, he said there is a requirement to set standards, guidelines and processes for healthcare delivery.
In his concluding remarks for the opening session, Mr Manasije Mishra, Chief Executive Officer, Max Bupa Health Insurance Company Ltd thanked the Secretary for his candid views and said industry sought his advice and guidance in addressing the two most important points raised by the Secretary – India’s spending on healthcare and OOPE.
In the session on “Insight from Select International Markets”, Professor Ranjit Roy Chaudhury, Advisor to the Hon. Minister of Health & Family Welfare, welcomed Dr Ascobat Gani, Health Economist and Advisor to the Ministry of Indonesia, Ms Elizabeth J Fowler, VP, Global Health Policy, Johnson & Johnson, Dr Sanjay Kinra, Reader in Clinical Epidemiology, UK to share their learnings and insights from their countries to address the 4 key challenges he identified for India: Can there be a universal package for a country with different levels of development and great diversity? How does one develop a model for a country with a federal structure? How can information technology be optimally leveraged? What kind of structure is required?
Sharing the US experience, Ms Elizabeth J Fowler, VP, Global Health Policy, Johnson & Johnson said that even though US spends 17% of GDP on healthcare, there are issues regarding accessibility and quality. The key challenges were rising health insurance premiums, low scores on key health indicators, loss in employer coverage, growing number of uninsured and concentrated health markets. The Obama Government then introduced a new system which focused on expanding coverage by building on the existing healthcare system, greater transparency, building a more efficient system, bringing in insurance market reforms and delivery systems and payment reforms and focusing on prevention and wellness. She shared some of the experiences - to expand coverage, the US had a multi-tiered scheme where the low-income group was covered in a public programme, the middle income group under private coverage with Government subsidy, and also introduced a website for greater coverage and transparency. For market reforms, the public and private sector shared data to address issues of frauds and increase prosecutions. Also, there would be no annual or lifetime limits on coverage. She said that India could take a few lessons from the way the US was addressing its challenges.
Dr Ascobat Gani, Health Economist and Advisor to the Ministry of Indonesia, said that India and Indonesia had several common challenges – of providing healthcare services to a population with great disparity and spread over a vast geographical area. He said initially the country had several schemes such as a Commercial Scheme (voluntary, for profit), a civil servant scheme, a worker scheme, a scheme for the poor, and local schemes, but the goal for 2019 is to move from several schemes to a single scheme, cover 100% of the population, offer a comprehensive benefit package, have no cost sharing at the service point, have access to quality health services among others. Indonesia is committed to providing a social security net to all its people, he said.
The challenges, he elaborated, are (a) capturing the informal sector workers (b) supply side readiness – Indonesia has fewer hospital beds and specialists (c) the escalating costs due to an aging population (d) financing public health – promotion, prevention.
To include more people from the informal sector, the most preferred option Indonesia felt was partial subsidy to attract and motivate them to pay premium. To contain costs, the options were to strengthen the public health programmes, primary care, have a good referral system, health technology assessment and a utilization review.
Dr Sanjay Kinra, Reader in Clinical Epidemiology, UK, shared the UK’s National Health Service (NHS) said that NHS is a taxation-funded free-at-the-point-of-use service. He advocated strong scientific underpinnings for all initiatives and highlighted three key areas for focus and improvement in India: Pre-approval assessment where data-driven systems and appropriate risk profiling is required; portfolio management where the focus should be risk management and disease programmes and healthcare provision which is largely unregulated and there is a pressing need for good clinical guidelines.
In his concluding remarks, Professor Ranjit Roy Chaudhury said that while scientific underpinnings are very important, as is prevention and promotion in public health, India should also leverage the vast knowledge it has in others streams of medicine such as Ayurveda, unani among others.
With “Leveraging the Power of a Billion People” as the theme, the Summit saw participation from key stakeholders in sessions on Deepening the Retail Health Insurance Market, Furthering the Partnership between Payers and Providers and Insights from Select International Markets where policy initiatives and other measures from countries such as Indonesia, UK, and USA were shared.