INDIA, US & UK HEALTH CARE SYSTEMS

A SMALL BRIEFB LEELA DHARMDHM (OU) 2014-16; AIHAROLL NO 1404-01-676031(INDIA)94904-68518; BOBBALEELADHAR@HOTMAIL.COM

INTRO

QUIZ(30

seconds)

HEALTH CARE SYSTEMS

B LEELA DHAR

ROLL NO - 31

MHM 2014-16

24 SEP 2014

KNOW ABOUT

UNITED STATES OF AMERICA

Capital Washington, D.C. - 38°53′N 77°01′W [4]

Government Federal Presidential Constitutional Republic

President - Barack ObamaIndependence from Great Britain - July

4, 1776Area - 96,29,091 km2Population – (2014 estimate)

31,87,76,000 Density - 34.2/km2 (180th)

GDP 2014 estimate $17.528 trillion (1st)

Per capita $54,980 (9th)Currency United States dollar ($) (USD)WORLD’S LARGEST NATIONAL

ECONOMY.14.5% UNDER POVERTY ONLY.23% OF GLOBAL NOMINAL GDP.19% PURCHASING POWER PARITY.

KNOW ABOUT

UNITED KINGDOM

Capital and largest city – London 51°30′N 0°7′W [3]

Government Parliamentary Constitutional Monarchy

Monarch Elizabeth IIPrime Minister David CameronLegislature ParliamentArea - 2,43,610 km2 (80th)Population - 2011 census 6,31,81,775 (22nd)Population Density 255.6/km2 (51st)

GDP 2014 -$2.828 trillion (6th)Per capita $43,830 (21st)78th-largest sovereign state 22nd-most populous countryWorld's first industrialised countryThe foremost power during the 19th and early

20th centuries.The UK remains a great power with

considerable economic, cultural, military, scientific, and political influence internationally

KNOW ABOUT

INDIA

Capital - New Delhi [28°36.8′N 77°12.5′E ]

Largest city - MumbaiGovernment Federal parliamentaryArea - 3,287,590 km2 (7)Population – (2011 census )

121,01,93,444 (2nd) Density 379.6/km2 (31st)

GDP (PPP) 2014 estimateTotal $5.425 trillion (3rd)Per capita $4,307 (133rd)

GDP (nominal) 2014 estimateTotal $1.996 trillion (10th)Per capita $1,584 (143rd)

AIM

TO ACQUAINT THE CLASS WITH THE

HEALTH CARE SYSTEMS OF US & UK AND REVIEW THEM

WITH REFERENCE TO OUR INDIAN HEALTH

CARE SYSTEM

PREVIEW

PART 1 - US HEALTH SYSTEM

PART 2 -UK HEALTH SYSTEM

(NHS)

PART 3 -

POINTS TO PONDER BY COMPARING WITH OUR OWN INDIAN HEALTH

SYSTEM

PREVIEW

PART 1

US HEALTH SYSTEM

MANPOWER14.4 MILLION

DRs (MD) DOsNURSES DENTISTSPHARMACISTS & ADMINISTRATORS

382,000 PERS

REHABILITATION SERVICE PERSONNEL INVOLVED IN PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS

US HEALTH SYSTEMHEALTH CARE CENTERS

5,700 Hospitals.15,900 Nursing Homes.2,900 Inpatient Mental Health Facilities.11,000 Home Health Agencies.

TRAINING INSTITUTIONS

144 MEDICAL AND OSTEOPATHIC SCHOOLS.56 DENTAL SCHOOLS.109 PHARMACY SCHOOLS.1,500 NURSING INSTITUTIONS.

800 GOVT PROGRAMS TO

COVERBASIC HEALTH SERVICES FOR

MIGRANT WORKERS.

THE HOME LESS.

COMMUNITY HEALTH WORKERS,

BLACK LUNG CLINICS.

HIV INTERVENTION CENTERS.

INTEGRATED PRIMARY CARE &

SUBSTANCE ABUSE TREATMENT

US HEALTH SYSTEM

US HEALTH SYSTEMMANAGED CARE SECTOR

ORGANISATIONS405 LICENSED HEALTH MAINTAINENCE ORGANISATIONS (HMOs)

925 PREFERRED PROVIDER ORGANISATIONS (PPOs)

COVERAGE.201.7 MILLION – PRIVATE HEALTH INSURANCE COVERAGE.

40.3 MILLION – MEDICARE BENEFICIARIES.

38.3 MILLION MEDICAID RECIPIENTS.

INSURANCE COMPANIES AND PLANS. COMPANIES - APPROX 1000.

PLANS - 70 BLUE CROSS/SHIELD.

US HEALTH SYSTEMNO UNIVERAL HEALTH CARE DELIVERY SYSTEM.

NO OF “MULTIPLE SUB-SYSTEMS” DEVELOPED THROUGH MARKET FORCES AND POPULATIONS SEGMENTS.

IT IS A MANAGED CARE SYSTEM OF HEALTH CARE.

SOME OF EFFECTIVE “PUBLIC FUNDED HEALTH CARE SYSTEM” IS “TRICARE”- A PROGRAM FINANCED BY MILITARY & “VA (VETERANS ADMINISTRATION) HEALTH CARE SYSTEM”.

US HEALTH SYSTEM – MANAGED CARE SYSTEM

US HEALTH SYSTEM – MANAGED CARE SYSTEM

US HEALTH SYSTEM – CHARACTERISTICSNO CENTRAL GOVERNING AGENCY AND LITTLE INTEGRATION

AND COORDINATION.TECHNOLOGY DRIVEN DELIVERY SYSTEM FOCUSSING ON ACUTE CARE.HIGH ON COST, UNEQUAL IN ACCESS, AVERAGE IN OUTCOME.DELIVERY OF HEALTH CARE UNDER IMPERFECT MARKET CONDITION.LEGAL RISKS INFLUENCE PRACTICE BEHAVIOURS.GOVERNMENT AS SUSIDIARY TO PRIVATE SECTOR.MARKET JUSTICE VS SOCIAL JUSTICE : CONFLICT THROUGHOUT HEALTHCARE.MULTIPLE PLAYERS AND BALANCE OF POWER.ACCESS TO HEALTH CARE SERVICES IS SELECTIVELY BASED ON INSURANCE COVERAGE.

US HEALTH SYSTEM – TRICARE SYSTEMTO ALL ACTIVE MILITARY PERSONNEL OF U.S. ARMY,

NAVY, AIR FORCE, COAST GUARD & SOME UNIFORMED-NON-MILITARY PERSONNELS BELONGING TO PUBLIC HEALTH SERVICE AND THE NATIONAL OCEANOGRAPHIC AND ATMOSPHERIC ASSOCIATION (NOAA).

WELL ORGANIZED & HIGHLY INTEGRATED SYSTEM.

COVERS PREVENTIVE & TREATMENT SERVICES.

COMBINES PUBLIC HEALTH WITH MEDICAL SERVICES.

ROUTINE AMBULATORY CARE – MILITARY PERSONNELS PLACE OF WORK/DISPENSARY/ SICK BAY/ FIRST AID STATION/ MEDICAL STATION.

ROUTINE HOSPITAL SERVICES – AT BASE DISPENSARIES/ SICK BAYS ABROAD SHIP/ BASE HOSPITALS.

COMPLICATED HOSPITAL SERVICES - REGIONAL MILITARY HOSPITALS

US HEALTH SYSTEM – VA (VETERANS ADMINISTRATION) SYSTEM

TO ALL RETIRED VETERAN MILITARY SERVICE PERSONNEL. (PRIORITY – DISABLED).ONE OF THE OLDEST (1946) AND FORMALLY ORGANIZED HEALTH CARE SYSTEM IN THE WORLD.MISSION – PROVIDE MED CARE, EDU & TRG, RESEARCH, CONTINGENCY SUPPORT AND EMER MGT FOR DoD MED CARE SYS.5.5 MILLION PERSONS COVERED.1,100 SITES INCL 153 HOSPs, 732 AMB & COMMUNITY BASED CLINICS, 135 NURSING HOMES, 209 COUNSELLING CENTERS, 47 DOMICILIARIES (RESIDENTIAL CARE FACILITIES), 73 HOME HEALTH CARE AND CONTRACT CARE PROGRAMMES.BUDGET $ 30 BILLION & STAFF 2,63,350 (2007 FIGS).22 GEOGRAPHICALLY DISTRIBUTED VETERANS INTEGRATED SERVICE NETWORKS (VISNs).

PART 2

UK HEALTH SYSTEM

[NATIONAL HEALTH SYSTEM]

[NHS]

NATIONAL HEALTH SYSTEM (NHS)

“The NHS belongs to the people. It provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief, gender reassignment, pregnancy and maternity, or marital or civil partnership status”.

NHS Constitution

NATIONAL HEALTH SYSTEM (NHS)

GENERAL DENTAL COUNCIL – 1,01,901.

GENERAL MEDICAL COUNCIL – 2,52,431.

HEALTH AND CARE PROFESSIONS COUNCIL – 3,10,942.

NURSING AND MIDWIFERY COUNCIL – 6,75,148

NATIONAL HEALTH SYSTEM (NHS)FOUR

HEALTH CARE SYSTEMS (1948)

NHS IN ENGLANDNHS IN SCOTLANDNHS IN WALESHEALTH & SOCIAL CARE IN NORTHERN IRELAND

FIVE DOMAINSPREVENT PEOPLE FROM DYING PREMATURELY.ENHANCING QUALITY OF LIFE FOR PEOPLE WITH LONG TERM CONDITIONS.HELPING PEOPLE TO RECOVER FROM EPISODES OF ILLHEALTH OR FOLLOWING INJURY.ENSURING THAT PEOPLE HAVE A POSITIVE EXPEREINCE OF CARE AND TREATING AND CARING FOR PEOPLE IN A SAFE ENVIRONMENT AND PROTECTING THEM FROM AVOIDABLE HARM.

NHS

NATIONAL HEALTH SYSTEM (NHS)

NATIONAL HEALTH SYSTEM (NHS)

PART 3

POINTS TO PONDER BY COMPARING WITH OUR OWN INDIAN HEALTH

SYSTEM

(DISCUSSION)

INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

INDIAN HEALTH CARE SYSTEM – A QUICK RECAP

DISCUSSION POINTS FOR

PART 3

HEALTH SYSTEMS in TRANSITION

( HiT ) IN 2011 BY SEAN BOYLECONTINUOUS STRUCTURAL CHANGE

– DRAG ON THE SYSTEM.

MECHANISMS SO DEVELOPED FOR COMMISSIONING HEALTH CARE WERE NOT EFFECTIVE.

THE INFORMATION WAS STILL NOT THERE TO ENABLE GOOD SYSTEM MANAGEMENT AT ALL LEVELS.

WIKIPEDIA VERSION ABOUT INDIAN HEALTH SYSTEM

NOMINAL HEALTH CARE SYSTEM. NOT ENOUGH HOSP, DOCTORS, MED STAFF, MEDICINES OR AMB SER. QUALITY OF CARE & ACCESSIBILITY POOR. MOST DEPEND ON PVT HOSP. VERY POOR PEOPLE, DEPEND ON GOVT HOSP. THIS CAN'T BE CALLED A HEALTH CARE

SYSTEM FROM A WESTERN PERCEPTIVE. THIS NOT AN ORGANISED OR FUNCTIONAL SYSTEM BUT A COLLECTION OF GOVT HOSP

IN DIFFERENT PARTS OF THE COUNTRY TO SERVE A HUGE POPULATION.INDIA RANKS LAST IN HEALTH CARE COMPARED TO OECD OR BRICS COUNTRIES. THE 12TH FIVE YEAR PLAN DOCU ON HEALTH HAS RECEIVED A LOT OF CRITICISM FOR

ITS LIMITED UNDERSTANDING OF UNIVERSAL HEALTH CARE AND FAILURE TO INCREASE PUBLIC EXPENDITURE ON HEALTH.

THE 12TH PLAN DOCUMENT EXPRESS CONCERN OVER HIGH OUT-OF-POCKET (OOP) EXPENDITURE, BUT IT DOES NOT GIVE ANY TARGET OR TIME FRAME FOR REDUCING THIS .

OOP CAN BE REDUCED ONLY BY INCREASING PUBLIC EXPENDITURE ON HEALTH AND BY SETTING UP WIDESPREAD PUBLIC HEALTH SERVICE PROVIDERS.

THE PLANNING COMMISSION IS PLANNING TO DO THIS BY REGULATING PRIVATE HEALTH CARE PROVIDERS.

INSTEAD OF DEVELOPING A BETTER PUBLIC HEALTH SYSTEM WITH ENHANCED HEALTH BUDGET, 12TH FIVE YEAR PLAN DOCUMENT PLANS TO HAND OVER HEALTH CARE SYSTEM TO PRIVATE INSTITUTIONS.

WIKIPEDIA VERSION ABOUT INDIAN HEALTH SYSTEMTHE 12TH PLAN DOCUMENT EXPRESSES CONCERN OVER RASHTRIYA SWASTHYA BHIMA

YOJANA BEING USED AS A MEDIUM TO HAND OVER PUBLIC FUNDS TO THE PRIVATE SECTOR THROUGH AN INSURANCE ROUTE.

THIS HAS ALSO INCENTIVIZED UNNECESSARY TREATMENT WHICH IN DUE COURSE WILL INCREASE COSTS AND PREMIUMS.

THERE HAS BEING COMPLAINTS ABOUT HIGH TRANSACTION COST FOR THIS SCHEME DUE TO INSURANCE INTERMEDIARIES.

RSBY DOES NOT TAKE INTO CONSIDERATION STATE SPECIFIC VARIATION IN DISEASE PROFILES AND HEALTH NEEDS.

EVEN THOUGH THESE THINGS ARE ACKNOWLEDGED IN THE REPORT, NO ALTERNATIVE REMEDY IS GIVEN.

NO REFERENCE TO NUTRITION (AS KEY A COMPONENT OF HEALTH) FOR UNIVERSAL PUBLIC DISTRIBUTION SYSTEM (PDS) IN THE PLAN DOCUMENT OR HLEG RECOMMENDATION.

IN THE SECTION OF NATIONAL RURAL HEALTH MISSION (NRHM), THE COMMITMENT TO PROVIDE 30- TO 50-BED COMMUNITY HEALTH CENTRES (CHC) PER LAKH POPULATION IS MISSING FROM THE MAIN TEXT.

ASHA (ACCREDITED SOCIAL HEALTH ACTIVIST) WORKER, A POOR WOMAN – PAYMENT INCENTIVE BASED.

DOCTORS, NURSES AND SPECIALIST SLEFT OUT.

A PEEP INTO INDIAN HEALTH CARE SYSTEM – FOR FUTURE HOSPITAL MANAGERS

A PEEP INTO INDIAN HEALTH CARE SYSTEM – FOR FUTURE HOSPITAL MANAGERS

CONCLUSION

LIKELY Qs

IN

SEMESTER

LIKELY Qs IN SEMESTER

LIKELY Qs IN SEMESTER

LIKELY Qs IN SEMESTER

1. WE HAVE BEEN RULED BY UK

FOR MORE THAN TWO

CENTURIES, FROM WHOM WE

INHERITED THE HEALTH CARE

SYSTEM. TODAY THE NHS OF

UNITED KINGDOM IS ONE OF THE

BEST HEALTH SYSTEMS IN THE

WORLD WHEREAS OUR INDIAN

HEALTH SYSTEM IS NO MATCH.

COMMENT ABOUT THE REASONS

AND SUGGEST MEASURES TO

IMPROVE THE EXISTING HEALTH

CARE SYSTEM.

LIKELY Qs IN SEMESTER

2. DISCUSS SIMILARITIES

BETWEEN US AND INDIA WITH

RESPECT TO THE HEALTH CARE

SYSTEM. SUGGEST MEASURES TO

BRING OUR EXISTING HEALTH

CARE SYSTEM AT PAR WITH US

HEALTH CARE SYSTEM OR EVEN

BETTER.

CREDITs

REFERENCES

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BIBLIOGRAP

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