A health  care  system is  the organization of people,  institutions,  and  resources  to deliver health  care services  to  meet the health needs of target populations

WHO has defined these goals as :– Good health– Responsiveness to the expectations of the

population– Fair financial contribution

Healthcare System - Goals

• Many  countries  are  struggling  to  address increasing  costs, poor or  inconsistent quality and inaccessibility to timely care

• Among  developed  countries,  healthcare expenditures are rising twice as fast as overall economic growth

• Finally,  as  costs  and  demand  rise,  access  to care  is  becoming  more  problematic.  Many healthcare  systems  have  demand  versus capacity  issues  that  are  extending wait times for services

Healthcare System – Current Scenario

        These  challenges  are exacerbated by driving  forces that are challenging the status quo– Globalization– Changing demographics and lifestyles– Diseases  that  are  more  expensive  to  treat  (for  example, rising incidence of chronic disease)

– Proliferation of medical technologies and treatments

• Greater  focus  on  value  from  the  entire  healthcare system

• Increasing need to activate responsible citizens• New approaches to promoting health and delivering care

• Growing resource challenges

Healthcare System – Focus Areas

Within developing countries, access to basic healthcare services  is seen to be extremely  limited and many simply lack access to even the most basic services. The causes can be enumerated as below: 

The Challenge in Emerging Economies

There are generally five primary methods of funding

health care systems:• General taxation to the state• Social health insurance• Voluntary or private health insurance• Out-of-pocket payments• Donations to charities

Most countries' systems feature a mix of all five modelsMost countries' systems feature a mix of all five models

Healthcare System - Funding

The effectiveness with which these instruments of state policy are designed and used determines the extent to which the health

system is equitable, appropriate or fair

Healthcare System - Aspects

Staying Healthy

Long Term Condns

Mental Health

Maternity & New Born

Care for Children

Acute Care

Planned Care

Monitoring /Preventing

Diagnosing Preparing/Intervening

Recovering Monitering/Managing

Franchising•PDA, Thailand•K-Met, Kenya•PSI, Various•MinuteClinic, U S•HealthStore,Kenya•GreenStar,Pakistan

Production Specialisation•Arvind Eye, India•LifeSpring, India•Narayana Hridyalaya, India

Technology Enabled Networks•Medical, Mexico•HMRI, India•NHS Helpline, U.K.•Care Mgmgt Co., U.S.•RapidSMS, Malawi•EMRI, India

Integrated Care•Valencia, Spain•Kaiser Permanente,U.S.

CATEGORIES

OF

CARE

CARE DELIVERY VALUE CHAIN

Six factors characterize these solutions, with each doing some or all of the following:

 2. Get close to the patient and follow established behaviour patterns: E.g., Aravind 

has engaged in out-reach strategies – taking care straight to the villages

4. Reinvent the delivery model by using proven technologies disruptively: E.g., MinuteClinic’s IT platforms under-pinning clinical procedures and decision making 

6. Confront professional assumptions and right skill the workforce: E.g., The use of community health workers at HealthStores reduces expenditure

8. Standardise operating procedures wherever possible: E.g., Aravind, HealthStores, MinuteClinic and PSI have all standardised their procedures

10. Borrow someone else’s assets: E.g., HealthStores relies on already established sites to base their micro-clinics

12. Open new revenue streams across sectors: E.g., PSI has shown its possible to cross sector boundaries to create new market opportunities in franchising

India’s challenges with respect to availability of healthcare are multi-fold

Closer Home – in INDIA

Some efforts are being made by both public and private players to address these issues :

• The government’s NATIONAL RURAL HEALTH MISSION program aimed at making infrastructure and resources available and functional.

• FOCUSED EDUCATIONAL PROGRAMMES such as Bachelor of Rural Healthcare and Rural MBBS are also on the anvil

• EMERGENCY AND REFERRAL TRANSPORT INITIATIVES such as EMRI, 108 and Janani express

• STREAMLINING PROCUREMENT OF DRUGS AND CONSUMABLES to improve availability at all public healthcare facilities

• USE OF MEDICAL MOBILE UNITS, e.g., the ‘Akha Boat’ initiative in Assam that provides basic healthcare services through mobile boats to the remote riverine islands of Assam

• PUBLIC-PRIVATE PARTNERSHIPS for operating healthcare infrastructure and medical equipment

• SET UP OF TERTIARY CARE CORPORATE HOSPITALS IN TIER II AND III CITIES and use of telemedicine by private players to reach a larger section of the country

In INDIA

Inclusive Healthcare

AVAILABILITY

AFORDABILITY

QUALITY

Long Term & Sustainable Solutions

“In healthcare you don’t do one big thing and reduce the price but have to do 1000 small things” – Dr. Devi 

Shetty Chairman, Narayana Hrudayalaya

Healthcare Delivery - Stakeholders

Stakeholders – The AIM

HEALTHCARE DELIVERY MODELS

Healthcare Delivery – Newer Models

Healthcare Delivery

Short  Stay  Surgeries  take  anywhere  between 24  -  72  hours  from  admission  to  patient discharge and may include Day Care Surgeries in which the patient is discharged within a day

Apart  from  cost  containment,  other  benefits of out patients surgery are :

• Decompression of busy hospital beds• Less nosocomial infections • Early  recovery  in  home  environment  with  the  family. Thus, there is less disruption of personal lives• Acceptance  of  day  care  surgeries  by  insurance companies has resulted in a win-win situation for all

Advantages

Merrygold  Health  Network  is  an  innovative Social  Franchising  Program  in  India  providing essential  health  care  services  to  the  poorer sections  in  the  society.  The  program  is  being implemented  through  a  Public  Private Partnership (PPP)

The Ministry of Health and Family Welfare (MOHFW), Government  of  India,  through  its  National  Rural Health  Mission  (NRHM)  has  introduced  the  rapid home pregnancy test kits (Nishchay)  

THE NISHCHAY PROGRAM 

  is not a program for the promotion of the pregnancy test kit alone,  but  is  an  entry  point  to  RCH  and  family  planning services  for women  seeking quality  and  assured  RCH  and  FP services.

Important key issues addressed by Nishchay are: Low  percent  of  women  starting  ANC  in  first  trimester  due  to  late 

detection Contraceptive  Provisioning  (IUD/Pill)  not  started  after  ruling  out 

pregnancy High unsafe abortions due to late detection of pregnancy

IV. SINGLE SPECIALTY HOSPITALS

• Cost efficiency due to higher volume• Provide  higher  quality  care  due  to 

greater specialization• Easily attract human resource• Economies of scale and scope• Ease of operation• Increase consumer satisfaction• Competitive  pricing  and  increased 

choice for consumer

Examples  :  Medfort  Hospitals,  Center for  Sight,  Aravind  Eye  Care,  Aster Vision, Renkare (dialysis centers)

Single Specialty Hospitals - Advantages

In  medicine,  end-of-life  care  refers  to  medical  care  not  only  of patients  in the final hours or days of their  lives, but more broadly, medical  care  of  all  those  with  a  terminal  illness  or  terminal condition that has become advanced, progressive and incurable. 

Therefore, end of life care centres have three objectives:• To reduce the agony and burden of prolonged dying process• To develop mental peace at the time of death• To establish ethical principles supporting death in the Indian hospitals

V. END OF LIFE CARE CENTERS

VI. OTHERS

Healthcare Transformation

Winning Transformation