“One Health Care One India”
Health Care Revolution
It is time to bring about the Health Care Revolution, by changing the way Healthcare is 'Financed and Delivered' in India. This is possible by making Indian healthcare, insurance driven and weaning the people from depending on the governments, for their health care need.
Health Care Financing
At present we adopt “Out of Pocket” “Self–funded schemes”, Welfare Trusts run schemes, or “Health Insurance” as the method to pay for the availed health care services. Out of these, Health Issuance seems to be the best method. But unfortunately it is not transansparent and accountable as one would like to see it. When each and every financial transaction is conducted through Banks only and when the entire care delivery and financing system get digitized, then only the scope for Moral Hazard reduces drastically. This will bring down the care cost, management costs and the insurance premium, thus paving the way for an affordable health insurance with a premium as little as a 'day`s wage' of a farm worker, to cover all ailments without age ristrictions and exclusion clauses.
We beleive, that the health insurance should be provided without any conflict of interest. This is possible when each of the stakeholder work in their area of core compitance. The operations like, the Care provision, Medical documentation, Claim process, Claim settlement, should be handled by different agencies without any insurance or bureaucratic interference. At present insurer and TPAs work together, as the result the policyholder suffer.
Health Care Delivery
Health Care is delivered by the 'Care Provider' comprising of the Doctors, Nurses, Technicians, Paramedics, etc., whereas the 'Health Care Infrastructure' is provided by the Hospitals, Nursing homes, Day Care Centers, Group Practices, Clinics, etc. Without the care providers the hospital is an empty shell. It is a house without people and it is the people make the house a home.
Hospitals
At present, we have the Government, Corporate, and Private Sector building Hospitals and delivering care. The quality of care provided by each of these hospitals, should be made the same and delivered at the same price, across India. These hospitals should allow free movement of doctors, nurses, technicians and paramedics between the hospitals. To maximise the utility of the existing skilled health workers, the government should allow the doctors to admit and treat their patients in any of these hospitals on a “Fee for service” basis, while making them responsible for patient care, and medical negligence. This will certainly end the shortage of doctors, nurses and other health workers and help in rapid knowledge and technology transfer across healthcare industry.
Need-based Health care
What India need is, Insurance driven Cashless Healthcare, where the care is delivered by the Doctors, and the patients are free to choose the doctor and hospital to get treated in their neighbourhood. The payment for the Services rendered by the “Health Care Provider” and Hospitals as the “Health care Infrastructure provider” should be settled by the Insurance Companies speperately, and directly through Banks
Health Insurance
Health Insurance is a well-structured mechanism to deliver quality care, and settle claims on a cashless basis. It works on the principle of risk pooling and risk sharing. Here, wider the insurance base, lesser is the premium and greater is the cover value. Interestingly here the hospitals, and the insurers, play the number game, to self sustain, and scale up.
Health Care Industry and Regulators
India has the healthcare infrastructure, manpower, insurer and banks in place, and so are the healthcare laws. Each one of them is licenced and regulated by the government agencies. People are not quite aware of it as of now. But then, the regulators do make mistakes, for lack of experts and experience. At the same time are adament to accept their mistakes and amend them. The IRDAI on one hand, licences TPAs as insurance intermediaries, but then do not allow TPAs to conduct business indipendently.
TPA in Healthcare, is no more insurance intermediaries but Medical Auditors
The IRDAI does not allow the TPAs to sell insurance policies and settle claims, in spite of that, try to regulate them on solvency and market issues, which they don`t have. In reality the TPAs are 'Medical Auditors' with no insurance responsibilities at all. Hence the TPAs services should be used by the insurer and claimants alike, on 'Fee for Service' basis. The Doctors, Advocates and Chartared accountants charge fees and people and institutions pay. The IRDAI cannot act as the agents of the Insurers and push TPAs to get empanelled with them to get business. This amounts to misusing the dominent position, promoting conflict of interest and corruption.
The Healthcare Industry has on one hand, the Care Providers and the Infrastructure Providers, to deliver care and on the other hand we have the Insurance Companies, Welfare Trusts, Government sponsered Schemes, to avail care and settle claims. Each one of them, is licensed and regulated by the specific government organization. The regulators are in the form of the National Medical Commision (NMC) for Doctors, State Government for hospitals, IRDAI for Insurance Companies and TPAs, and RBI for Banks. To provide justice to all, we have the Judiciary.
One Health Care One India
To make healthcare affordable and available, inclusive and participatory, India needs insurance driven healthcare in the form of 'One India One Health Care' where the Center and the State governments participate with the Families, to share and pay the Health Insurance Premium at 60:40:40 ratios respectively. When the family group health insurance premium of Rs.1500 per family, is shared and paid, then the shared amount would be Center Rs.600, State Rs.450 and the Family Rs 450, respectively. Here the family pays only Rs.450 per year, which is less than a day`s wage of a farm worker,
No need for Government Schemes
Once 'One India One Health Care' is in place, then there is no need for the Governments to carry on with Schemes like Vajpayee Arogyashree, Rajiv Arogya Bhagya, Rashtriya Swasthya Karyakram under the department of health and family welfare, NRHM, RSBY, ASHA, AYUSH, United Fund for Sub Centers, RSK, mobile health units. The money spent on these Schemes should be used to share and pay the Premium as is needed,
Government Schemes
The present government schemes simply adds tadds costs, duplicates work and gives less of healthcare. These schemes are used to rehabilate the retired bureaucrats in its management with no benifit to people at all.
Simplifying Healthcare
Anyuta Trust, simplify health care and makes it cashless, inclusive, participatory and transparent. Here the care is provided to the rich and poor alike and at the same price. This is the real cross subsidy, where the rich pay for the poor and young for the old. In this Trust run healthcare model, one can see product optimization, digitization, creating jobs at all skill levels, helping people to upgrade their existing skills and learn new skills, closing all windows of corruption, taking banking and insurance to corners of India. In this healthcare there is no burden on the State Exchequer and the poor. The scheme is run by cloud funding.
Disruptive Innovation
In Anyuta Trust dream and activities, one can see the application of cutting edge technology and skilled manpower to reduce Care Costs, Administration Costs, and elimination of Moral Hazards. Here is a system with in-built checks and balance, generating abundant data, to analyse for future innovation. All this is by touching the hearts of people and with an insurance premium as little as a day`s wage of a farm worker, to avail seamless hospitalised care, at the same price, at any of the Indian hospitals, anywhere in the country.
This is the closest one can get in healthcare, making it affordable, cashless, paperless, without moral hazards, bureocratic interference, financial constrains for doctors to work and to end corruption. We need government help to complete the process.
Surely this is the distructive innovation leading to “Health Care Revolution” beyond borders. Subscribe and join us to experience them all.