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India Potential role for Disease Management in the Indian Healthcare System, & the
Role of private sector companies in its development
Disease Management Leadership Forum, DMAA, Las Vegas , USA . September 17th ,2007
Rajendra Pratap GuptaVice Chairman
Heartline Telemedical Services Pte Ltd.India
© Rajendra Pratap Gupta. E-mail- [email protected]
Total area 1.27 Sq.Mi - About 1/3rd the size of US
Total Population 1.1 Billion
Density 324 / Sq. Km
Annual Population Growth 1.3 %
Urban Population 27.8 % Rural Population 72.2 %
India – Some Facts
© Rajendra Pratap Gupta. E-mail- [email protected] Source : U.S. Deptt. of State .http:/www.state.gov/r/pa/ei/bng/3454.htm
GDP (FY 2005-06) $797 Billion
Real growth rate (FY 2005-06) 8.4 %
Per capita GDP (FY 2005-06) $761
India occupies 2.4 % of the world’s land area, it supports 15% of the world’s population
India – Some Facts
© Rajendra Pratap Gupta. E-mail- [email protected] Source : U.S. Deptt. of State .http:/www.state.gov/r/pa/ei/bng/3454.htm
Percentage of Population under age 15 Years –2002 33 %
Percentage of Population over age 65 Years –2002 5 %
Percentage of Population living in Urban areas –2000 28 %
Average Total Fertility rate (2000-05 ) 3
Life Expectancy at Birth (Years) 2000-05 Female 65 / Male 64
India – Some Facts
© Rajendra Pratap Gupta. E-mail- [email protected] Source : World Resources Institute. http:/earthtrends.wri.org.
Infant Mortality Rate per 1,000 live births 64.5
Maternal Mortality Ratio per 100,000 live births 540
Median age of total Population 24.5
India – Some Facts
© Rajendra Pratap Gupta. E-mail- [email protected] Source : UNFPA . http:/www.unfpa.org/profile/india.cfm
Population living below $ 1 / day , Per Cent 44.2
Illiteracy Rate of the Population , Per Cent 31.75
Physicians ( Density per 1000 population ) 0.60 (2004)
Nurses ( Density per 1000 population ) 0.80 (2004)
Midwives ( Density per 1000 population ) 0.47 (2004)
Dentist ( Density per 1000 population ) 0.06 (2004)
Pharmacists ( Density per 1000 population ) 0.56 (2003)
India – Some Facts
© Rajendra Pratap Gupta. E-mail- [email protected] Source : WHO . http://www.who.in/whois/databases/core/core_select_process.cfm
Hospital Beds ( Density per 1000 population) 0.70 (2002)
Total Expenditure on Health as a Percentage of GDP 5.0
General government expenditure on Health as a percentage of total Expenditure on Health 17.3
Private expenditure on Health as a percentage of total Expenditure on Health 82.7
General government expenditure on Health as a percentage of total government expenditure 2.9
India – Some Facts
© Rajendra Pratap Gupta. E-mail- [email protected] Source : http:/www.who.int/whois/database/care/core_select_process.cfm. Year 2004 * Frost & Sullivan 05
Spending on Health by household as a percentage of total Expenditure 8.2*
Per Capita total expenditure on health at average exchange rate (US $ ) 31.4
Per capita government expenditure on Health at average exchange rate (US $ ) 5.4
India – Some Facts
© Rajendra Pratap Gupta. E-mail- [email protected] Source : http:/www.who.int/whois/database/care/core_select_process.cfm. Year 2004
Out –of-pocket expenditure as a percentage of private expenditure on Health 93.80
Private Health Insurance coverage as a percent of population 2%
© Rajendra Pratap Gupta. E-mai: [email protected]
Government Private Sector
Provides Healthcare services free of cost to mostOf the people
Provides majority of Healthcare services and funding
Healthcare Services
Indian Healthcare System
© Rajendra Pratap Gupta. E-mail- [email protected]
Why Disease Management is required in India
Out –of-pocket expenditure as a percentage of private expenditure on Health is 93.80 %
75.3 % of the Children( Below 3 Years in Age ) in Rural areas & 70.8 % in Urban area are Anaemic
Two persons die of TB every minute. More than 1000 die every day
There are 2 –2.5 Million new patients of Cancer every year
53 % of all deaths are due to NCD’s
India – Why Disease Management
© Rajendra Pratap Gupta. E-mail- [email protected]
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
Government Expenditure on Health
1.28 1.391.61
1.93
2.4
0
0.5
1
1.5
2
2.5
3
FY 2002-03 FY 2003-04 FY 2004-05 FY 2005-06 FY 2006-07(RevisedEstimate)
US $ Billion
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
Population distribution age wise –Year wise
341.8 342.4 342.8 342.9 342.7 342.3
605.2 618.4 631.6 644.7 657.8 670.9
65.3 66.9 68.6 70.5 72.5 74.6
0
100
200
300
400
500
600
700
800
2000 2001 2002 2003 2004 2005
Pop
ulat
ion
in M
illio
n
0-14 Years 15-60 Years 60 Years +
© Rajendra Pratap Gupta. E-mail- [email protected] Source: Annual Report 2006-7, MOHFW, GOI
Projected deaths by cause,30-59 Years ,2005
9%
25%
9%30%
2%
17%8%
Cancer
CardiovascularDisease
Chronic RespiratoryDisease
Communicable,Maternal &Perinatal,NutritionalDeficienciesDiabetes
Injuries
Other ChronicDiseases
Doctor patient ratio
> 30 % population is illiterate
Problem compounded by lack of trained pharmacists
Health awareness is an issue with rural population
Indians are genetically predisposed to CVD & Diabetes
India – Why Disease Management
© Rajendra Pratap Gupta. E-mail- [email protected]
Of All the patients who are prescribed Medicines*
1/3rd take the drugs as told
1/3rd comply only partially
1/3rd do not comply at all
2/3rd Patients need disease management programs
India – Why Disease Management
© Rajendra Pratap Gupta. E-mail- [email protected] Source: Study conducted by The Tribune – NCR Edition
50% of the medicines prescribed are not taken at all – WHO
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
Disease Management Program of the Government of India
Modified Leprosy Elimination Campaign ( MLEP )
Package of IEC & MDT
SAPEL for Rural , LEC for Urban areas & NGO’s were involved
9,90000 new patients were brought under this program between 1997-2003
National Leprosy Eradication Program - NLEP
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Source : Annual Report 2006-7, MOHFW,GOI
More than 8.5 Million cases of TB
1/5th of new cases worldwide are from India
RNTCP launched in 1997 March. By 2006 March 1114 Million people were covered
Includes training material for staff, 11,800 diagnostic centres
Treated 6.30 Million patients.
National TB control Program - RNTCP
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Source : Annual Report 2006-7, MOHFW,GOI
Treatment Success rate increased from 25 to 85 %. Death rate reduced from 29 to 4 %
2.-2.5 Million Cancer patients
NCCP launched in 1975-6.
Regional Cancer Centers, Development of Oncology wing, DCCP, DNGO’s
IEC, Cancer Awareness Day , National Strategy task force
National Cancer Control Program - NCCP
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Source : Annual Report 2006-7, MOHFW,GOI
Onconet India
1st HIV patient detected in 1986. In 2005, 5.2 Million patients
85.8 % transmitted through Sexual infections
39 % of the patients are women
101 ART Centers in 29 states
National Aids Control Program -NACP
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Source : Annual Report 2006-7, MOHFW,GOI
52663 patients were put on free ART
10 Million patients without proper treatment
1 Psychiatrist for every million population
NMHP includes IEC
Strengthening of Hospitals
National Mental Health Program
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
National Program for Prevention & Control of Diabetes , CVD & Stroke - NPCDS
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
Cancer CVD Diabetes RespiratoryDiseases
Deaths in 2005
Prevalence of CHD was 9.6 % in Urban & 3.74 % in Rural - 1996
1.5 Million die of CHD every year
NPCDS pilot started in 2006-7
Integrated approach
Reduce prevalence of risk factors
National Program for Prevention & Control of Diabetes , CVD & Stroke - NPCDS
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
Reduce morbidity and mortality
Build capacity of the Healthcare system
Prevention through Health Promotions & establish guidelines
Setting up of National NCD cell, 6 RRC’s & State NCD cells
IEC strategy
National Program for Prevention & Control of Diabetes , CVD & Stroke - NPCDS
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
Disease Management Program in Private Sector
Basically are Patient Relationship Programs
Covers Diabetes, Cancer , Neuropathy pain, Glaucoma, Obesity , Arthritis, Erectile Dysfunction & Renal impairment
Cost of the DSM program is borne by the pharmaceutical companies
Services include call center helpline, onsite Counselors, Physiotherapists & Phlebotomist
The organization has been providing service for the last 6 years across 22 towns
DSM company A
© Rajendra Pratap Gupta. E-mail- [email protected]
© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI
Disease Management Program in Insurance Sector
© Rajendra Pratap Gupta. E-mail- [email protected] Conversion : Rs.4100 Crore = 1 Billion US$ Source: IRDA, Weighted New Business Premiums for
individual business
The industry has seen an unprecedented growth during the current year
YOY Growth – Health Insurance Industry
29
16% 17%
34%
132%
0%
20%
40%
60%
80%
100%
120%
140%
FY 2004 FY 2005 FY 2006 FY 2007 ( 09Months )
© Rajendra Pratap Gupta. E-mail- [email protected] Source: IRDA, Weighted New Business Premiums for individual business
YTD Dec FY07
Others, 9.4%Reliance Life*, 4.2%
Tata AIG, 4.5%
Birla SunLife, 5.3%
Aviva Life, 5.3%
Max NYL, 6.7%
SBI Life, 7.6%
ICICI - Pru, 29.1%
Bajaj Allianz , 18.3%HDFC Standard,
9.5%
Market share: Private retail
Private market size – US$ 1.92 Billion
© Rajendra Pratap Gupta. E-mail- [email protected]
Diabetes Care Proposition – Private Co.
Partnerships with wellness providers
Reminders for testing & Home collection of samples
Web support to facilitate self-management
Co-promotion of support groups
Free regular check-ups & annual consultations
Reduction of premiums based on control
Diabetes Care
© Rajendra Pratap Gupta. E-mail- [email protected]
Insurance Company – Private Sector
• Diabetes Care: First ever critical illness plan for Diabetics
– Provides financial support to meet cost of complications
– Incentive for compliance through premium reduction
– Wellness proposition through partnerships
– Balance between cost, quality and access to diabetes care
© Rajendra Pratap Gupta. E-mail- [email protected]
Incentives for control
Age bandPremium reduction
(Level 3)Premium increase
% diff in Premium (best & worst
control)
25-35 15% 10% 29%
36-50 20% 15% 44%
>50 30% 17.5% 68%
33
Launched in August 2007
Plans to cover 1-2 million lives in the next 2-3 years
Prevention and Wellness programs for its customers
Health Insurance company B
© Rajendra Pratap Gupta. E-mail- [email protected]
Launched in August 2007
Plans to cover Elderly . Premiums @ US$ 121 for a cover of US$ 2439
No pre-acceptance medical screening . Covered for life.
Health Insurance company C
© Rajendra Pratap Gupta. E-mail- [email protected]
Those who have no illness. Get ‘Good Features Discount’ @ 10 %
Diabetes Safe Policy is meant for known Diabetics. Annual Premium starts @ US$ 20
Currently in the fifth year
Till date 9309937 lives have been enrolled
This year the enrolments have been 2.22 Million lives
1st & 2nd year premium US$ 1.46 / year & from 3rd Year US$ 2.92
Covers all pre-existing illnesses
Innovative Scheme launched by a Hospital
© Rajendra Pratap Gupta. E-mail- [email protected]
Till date there has been 345854 free OPD consultations and 84721 surgeries
Self funded scheme and is being piloted in the state of Karnataka
The Governments plays the role of Risk Manager
Focus is on early diagnosis through regular health camps
© Rajendra Pratap Gupta. E-mail- [email protected]
The Scheme is targeted at the lower strata of the society
Innovative Scheme launched by a Hospital
Private companies act as Initiators & Innovators
Government steps in as a growth catalyst and later as a regulator
Finally big corporations & MNC’s to dominate the industry
The Way Forward………
© Rajendra Pratap Gupta. E-mail- [email protected]
The rising healthcare costs coupled with a huge population
Increasing incidence of NCD’s
Increased Healthcare spending by the government
The Way Forward………
© Rajendra Pratap Gupta. E-mail- [email protected]
Disease state management is the best way forward for India
Rajendra P. GuptaE-mail: [email protected]: +91-9867300045 +91-9323109456
Thank You !
© Rajendra Pratap Gupta. E-mail- [email protected]