Insurance based Social healthcare system (SHS)
Explain your idea in details:
Need: India has a vast healthcare system, comprised of Private and Public health systems. Despite which India lags behind when it comes to health indicators. One of the major setbacks with Indian healthcare system comes with 70% out-of-pocket expenditure. Catastrophic health expenditure gives rise to poverty which further deteriorates health seeking behaviour and overall health of the population. While both public and private systems of India come with various disadvantages; SHI aims to develop a system that focuses on advantages while eliminating the cons. Objectives: 1. Reduce financial burden by planning health finance and prevent catastrophic healthcare expenditure. 2. Improving health by providing quality preventive, primary, secondary and tertiary healthcare. 3. Reducing health inequities. Approach: Aim of SHI is to replacing Out-of-pocket expenditure with pre-payment. Purpose of SHI is to reduce the catastrophic health expenditure as healthcare of people who are insured will be covered completely. People will voluntarily purchase the insurance; and those who decide to be part of SHI will be covered for their healthcare needs including primary care, diagnostics, medicines, surgery and hospital stay. A system which is accessible and affordable; like public health system and focuses on advanced quality of treatment, like private health sector. A referral system will be implicated; encouraging patients first contact in primary care centre. Other services will be administered only when referred and needed. Apart from health centres efforts will also be concentrated on the prevention and promotion of health, to reduce overall health burden and suffering. Activities: 1. Infrastructure building or partnering with existing health providers. 2. Introduce and promoting membership of SHI by purchasing the insurance. 3. Plan the budget and administration. 4. Plan monitoring and evaluation body. 5. Design service delivery mechanism. 6. Employ human resource. 7. Connect providers and beneficiary to deliver health services.
Expected impact of your idea on sustainable development
Targets 1. Increasing focus on primary healthcare by making primary health centre as a mandatory first contact 2. Preventing moral hazard by applying minimal user fees at primary centre 3. Controlling burden of disease by early diagnosis and appropriate treatment 4. Reducing the work-load of the healthcare staff by streamlining the referral system 5. Efforts to prevention and promotion approach towards healthcare 6. Covering all the healthcare needs of the beneficiaries Monitoring and Evaluation 1. Quality audit and accreditation to maintain excellence 2. Regular financial audit 3. Maintain transparency of funding by displaying collection and distribution of the funds on the website which is updated regularly 4. Use of Health Management Information System (HMIS) to streamline the linkage, process of healthcare delivery and monitoring 5. Preventing medical practices by maintaining the transparency with help of HMIS
Plans for implementation and sustainability
Plans for implementation: Financial- 1. Capital is needed to build the infrastructure (One hospital per district and primary health centres according to the area of district) and to kick-start the system. 2. Insurance will be collected from each beneficiary according to their economic status. Each beneficiary can choose plan according their need and preference. 3. Insurance pool will be generated out of all the funds gathered. Funds then will be directed under various trajectories including; infrastructure and maintenance, salaries of human resource, medicines and other medical supply, medical equipment and machineries. Service delivery- 1. Primary centre will be the first contact for beneficiaries. Co-payment system will be there at the primary centre level to prevent moral hazard. Patients will then be either treated at the primary level or referred to hospital if further care is needed. 2. Medicines will be available at the primary centre; cost of which will be covered under SHI. 3. If sent to hospital patient will be seen by particular specialist. Diagnostic tests will be performed if necessary. Further according to the requirement hospital stay, surgery and intensive care will be taken care of at the hospital. Complete care will be covered under SHI. Sustainability: Once the infrastructure is built and there is a regular flow of insurance premiums; this model will be self-sustainable without needing any additional funds.
My name is Yojana (27 yrs), I am from India. I recently completed my Masters in Public Health and I did my under-graduation in Physiotherapy. I have been associated with healthcare system through the clinical and administrative approach during my education and work experience. I wish to learn more about healthcare system and contribute in its strengthening.