ROLE & PERFORMANCE OF QUALITY HEALTHCARE IN INDIA

ROLE & PERFORMANCE OF ROLE & PERFORMANCE OF QUALITY HEALTHCARE IN QUALITY HEALTHCARE IN

INDIAINDIA

UMA KLECTURER IN COMMERCEGOVT. FIRST GRADE COLLEGE, KUVEMPUNAGARMYSORE.

11th , september 2015, JSS COLLEGE FOR WOMEN,MYSORE.

HEALTH IS A HUMAN RIGHTHEALTH IS A HUMAN RIGHTITS AFFORDABILITY & ACCEPTABILITY HAS TO ITS AFFORDABILITY & ACCEPTABILITY HAS TO BE ASSURED FOR URBAN A/W/A RURAL, WELL BE ASSURED FOR URBAN A/W/A RURAL, WELL

TO DO TO THE POORER SECTION OF THE TO DO TO THE POORER SECTION OF THE SOCIETY.SOCIETY.

Introduction :Introduction :Health care delivery has become one of the most significant Health care delivery has become one of the most significant

economic and political issues of the 1990s. With attempts to restructure economic and political issues of the 1990s. With attempts to restructure the industry for the 21st century come important implications for the the industry for the 21st century come important implications for the marketing of health services. In India uninsured and low-income adults marketing of health services. In India uninsured and low-income adults experience substan tial health and health care inequities when compared experience substan tial health and health care inequities when compared with insured and higher-income individuals.with insured and higher-income individuals.The role and the importance of health care systems in the quality of life The role and the importance of health care systems in the quality of life and social welfare in modern society, have been broadly wellrecognized.and social welfare in modern society, have been broadly wellrecognized.

Health Care scenario:Health Care scenario:•Before independence Before independence - dismal condition.- dismal condition.•High morbidity, mortality and Infectious diseases.High morbidity, mortality and Infectious diseases.•After independence - emphasis on PH care.After independence - emphasis on PH care.

Present Problem:Present Problem:•High mortality, negligible MCH care.High mortality, negligible MCH care.•Urban-Rural divide:70:30.Urban-Rural divide:70:30.•Population Size of the country.Population Size of the country.•Declining funds to HealthCare Sector-CG/State.Declining funds to HealthCare Sector-CG/State.

Literature review:In 19th century: The root of Quality assurance initiatives in healthcare Florence Nightingale’s as far backIn1913: The American College of Surgeons(ACS) was founded great variations in the quality of healthcareBy 1917 and 1930: The ACS developed the Hospital Standardization processBy 1992: The American Society for Quality (ASQ) healthcare played role of improving healthcare qualityBy 1997: Quality Councilof India(QCI) was established as an autonomous body-National Accreditation broad for Hospitals and healthcare providers (NABH)

What to expect from healthcare What to expect from healthcare ??Fundamentally, delivery of healthcare should be:Fundamentally, delivery of healthcare should be:

SafeSafeEffectiveEffectivePatient-centeredPatient-centeredTimelyTimelyEfficientEfficientAccessibleAccessibleEquitable &Equitable &Consistent with good outcomesConsistent with good outcomesTracking…Tracking…RegulationRegulationCitificationCitificationAccreditation & CredentialingAccreditation & CredentialingGrading/ RatingGrading/ RatingQuality AwardsQuality Awards……..and Others???..and Others???

INDIAN HEALTH CARE SCENARIOINDIAN HEALTH CARE SCENARIO

Unequal distribution of healthcare resourcesUnequal distribution of healthcare resources Lack of strict regulationLack of strict regulation Rising costsRising costs Wide inequality in healthcareWide inequality in healthcare Gender inequality Gender inequality High cost of imported equipmentHigh cost of imported equipment Change from govt. sector domination to private sector in the last 20 Change from govt. sector domination to private sector in the last 20

yearsyears Large affordable middle classLarge affordable middle class Medical tourism on the rise Medical tourism on the rise Revolution in India over the last decadeRevolution in India over the last decade Increasing public awareness & private investments in healthcareIncreasing public awareness & private investments in healthcare Complicated cases used to go to govts. teaching hospitals.Complicated cases used to go to govts. teaching hospitals. Achievements in quality in many hospitals on par with western Achievements in quality in many hospitals on par with western

standardsstandards

AIMS & ROLES OF HEALTHCARE SERVICES FOR IMPROVEMENTAIMS & ROLES OF HEALTHCARE SERVICES FOR IMPROVEMENTThere were identified 9 aims for improvement in healthcare services they There were identified 9 aims for improvement in healthcare services they

are:are:

1.1. Safe:Safe: avoiding injuries to patients from care that is intended to help avoiding injuries to patients from care that is intended to help them.them.

2.2. Effective:Effective: providing services based on scientific knowledge to all who providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those unlikely could benefit, and refraining from providing services to those unlikely to benefit (avoiding underuse and overuse).to benefit (avoiding underuse and overuse).

3.3. Patient-centered:Patient-centered: providing care that is respectful of and responsive to providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that individual patient preferences, needs, and values and ensuring that patient values guide clinical decisions.patient values guide clinical decisions.

4.4. TimelyTimely: reducing waits and sometimes harmful delays for both those : reducing waits and sometimes harmful delays for both those who receive and give care.who receive and give care.

5.5. Efficient:Efficient: avoiding waste, such as waste of equipment, supplies, ideas, avoiding waste, such as waste of equipment, supplies, ideas, and energy.and energy.

6.6. Equitable:Equitable: providing care that does not differ in quality because of providing care that does not differ in quality because of personal characteristics such as gender, ethnicity, geographic personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.location, and socioeconomic status.

7.7. Better Care:Better Care: Improve the overall quality, by making health care more Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe. patient-centered, reliable, accessible, and safe.

8.8. Healthy People/Healthy Communities:Healthy People/Healthy Communities: Improve the health of the India, Improve the health of the India, population by supporting proven interventions to address behavioral, population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to social and, environmental determinants of health in addition to delivering higher-quality care. delivering higher-quality care.

9.9. Affordable Care:Affordable Care: Reduce the cost of quality health care for Reduce the cost of quality health care for individuals, families, employers, and government. individuals, families, employers, and government.

Healthcare Trends for 2015Healthcare Trends for 2015Technology is Transforming the entire healthcare industryTechnology is Transforming the entire healthcare industryWearable Tracking DevicesWearable Tracking DevicesPatient Centered CarePatient Centered CareIncreased Data DemandsIncreased Data DemandsAttaining Meaningful UseAttaining Meaningful UseSwitching to ICD-10Switching to ICD-10Data SecurityData Security

Current Health Problems in India:Current Health Problems in India:Morbidity & Morality StatisticsMorbidity & Morality StatisticsDemographic conditions of the populationDemographic conditions of the populationEnvironmental factors influencing healthEnvironmental factors influencing healthSocial-economic factors influencing healthSocial-economic factors influencing healthCultural & its componentsCultural & its componentsMedical & Health services availableMedical & Health services availableOther services availableOther services available

The importance of healthcare in india:The importance of healthcare in india:Achievements in health worldwide in the twentieth century and Achievements in health worldwide in the twentieth century and especially during the past few decades are impressive. The increase in especially during the past few decades are impressive. The increase in life expectancy and the decrease in fertility throughout the world have life expectancy and the decrease in fertility throughout the world have been greater in the past 40 years than during the previous 4000 years. been greater in the past 40 years than during the previous 4000 years. Life expectancy is almost 25 years longer today than at similar income Life expectancy is almost 25 years longer today than at similar income levels in 1900 (Preker A. et al 2000).levels in 1900 (Preker A. et al 2000).

Emerging trend in health careEmerging trend in health careHealth care has emerged as one of the largest service sectors in India, Health care has emerged as one of the largest service sectors in India, rather dynamic, it is constantly developing building further on the rather dynamic, it is constantly developing building further on the areas it is most competent areas it is most competent The health care deals with different services such as hospital services, The health care deals with different services such as hospital services, diagnosis services, physician consultancies and some other emerging diagnosis services, physician consultancies and some other emerging fields. In the present study, the focusing services are all health care fields. In the present study, the focusing services are all health care services together.services together.

At present mainly three policy initiatives At present mainly three policy initiatives are in progress for are in progress for health care for the poor. These include:health care for the poor. These include:

1.1. Exemptions to the poor from users fee in government hospitals; Exemptions to the poor from users fee in government hospitals; 2.2. Provision of free of cost treatment to poor (subject to a proportion of Provision of free of cost treatment to poor (subject to a proportion of

total patients) in private super-speciality hospitals; &total patients) in private super-speciality hospitals; &3.3. Health insurance schemes for the poor.Health insurance schemes for the poor.

Twelfth five year plan for healthcare in India:Twelfth five year plan for healthcare in India:The long term objective of this strategy is to establish a system of The long term objective of this strategy is to establish a system of Universal Health Coverage (UHC) in the country. Following are the 12th Universal Health Coverage (UHC) in the country. Following are the 12th plan period strategy:plan period strategy:

Substantial expansion and strengthening of public sector health care Substantial expansion and strengthening of public sector health care system, system, Health sector expenditure by central government and state government, Health sector expenditure by central government and state government, will have to be substantially increased by the twelfth five-year plan. will have to be substantially increased by the twelfth five-year plan. Financial and managerial system will be redesigned to ensure efficient Financial and managerial system will be redesigned to ensure efficient utilization of available resources and achieve better health outcome. utilization of available resources and achieve better health outcome. Increasing the cooperation between private and public sector health care Increasing the cooperation between private and public sector health care providers to achieve health goals. providers to achieve health goals. The present Rashtriya Swasthya Bhima Yojana (RSBY) which provides The present Rashtriya Swasthya Bhima Yojana (RSBY) which provides cash less in-patient treatment through an insurance based system .Below cash less in-patient treatment through an insurance based system .Below Poverty Line(BPL) population will be covered through RSBY schemePoverty Line(BPL) population will be covered through RSBY schemeIn order to increase the availability of skilled human resources, a large In order to increase the availability of skilled human resources, a large expansion of medical schools, nursing colleges, and so on, expansion of medical schools, nursing colleges, and so on, A series of prescription drugs reforms, promotion of essential, generic A series of prescription drugs reforms, promotion of essential, generic medicine and making these universally available free of cost to all patients medicine and making these universally available free of cost to all patients in publicin publicEffective regulation in medical practice, public health, food and drugs is Effective regulation in medical practice, public health, food and drugs is essential to safeguard people against risks and unethical practices. essential to safeguard people against risks and unethical practices. Plan will continue to have a mix of public and private service providers. Plan will continue to have a mix of public and private service providers.

QUALITY IMPROVEMENT & PERFORMANCEQUALITY IMPROVEMENT & PERFORMANCEQuality improvement (QI) consists of systematic and continuous Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services actions that lead to measurable improvement in health care services and the health status of targeted patient groups.and the health status of targeted patient groups.Using knowledge gained from the disciplines of medicine, nursing, Using knowledge gained from the disciplines of medicine, nursing, health-care management, and medical and health-services research, it health-care management, and medical and health-services research, it attempts to mobilize people within the health-care system to work attempts to mobilize people within the health-care system to work together in a systematic way to improve the care they provide.together in a systematic way to improve the care they provide.

QI program may appear different following four key QI program may appear different following four key principles: they are -principles: they are -

1.1. QI work as systems and processesQI work as systems and processes2.2. Focus on patientsFocus on patients3.3. Focus on being part of the teamFocus on being part of the team4.4. Focus on use of the dataFocus on use of the data

The overall performance of the health care organization among the The overall performance of the health care organization among the patients in two different type of organizations are measured separately patients in two different type of organizations are measured separately at five point scale namely highly satisfied, satisfied, moderate, at five point scale namely highly satisfied, satisfied, moderate, dissatisfied and highly dissatisfied.dissatisfied and highly dissatisfied.

10 Dimensions of healthcare quality10 Dimensions of healthcare qualityAvailability & AppropriatenessAvailability & AppropriatenessAccessibility & AffordabilityAccessibility & AffordabilityEquity & EqualityEquity & EqualityTechnical Competence & skillsTechnical Competence & skillsTimeliness & continuityTimeliness & continuitySafetySafetyRespect & Caring (I.P. relations)Respect & Caring (I.P. relations)EfficiencyEfficiencyEffectiveness& EfficiencyEffectiveness& EfficiencyAmenitiesAmenities

3 Perspectives’ of Healthcare Quality3 Perspectives’ of Healthcare QualityHealthcare Staff(Service providers)Healthcare Staff(Service providers)Health Manager(administration)Health Manager(administration)Clients (external & Internal)Clients (external & Internal)

PROBLEMS IN QUALITY HEALTH CAREPROBLEMS IN QUALITY HEALTH CARE

Unusual practices Unusual practices by medical professionals in pricing of their services.by medical professionals in pricing of their services.Variation in services:Variation in services: There continues to be a pattern of wide variation  There continues to be a pattern of wide variation in health care practice, including regional variations and small-area in health care practice, including regional variations and small-area variations. variations. Underuse of servicesUnderuse of services. Millions of people do not receive necessary care . Millions of people do not receive necessary care and suffer needless complication: that add to costs and reduce and suffer needless complication: that add to costs and reduce productivity. productivity. Overuse of servicesOveruse of services: Each year, millions of peoples receive health care : Each year, millions of peoples receive health care services that are unnecessary, increase costs, and may even endanger services that are unnecessary, increase costs, and may even endanger their health. Research has shown that this occurs across all their health. Research has shown that this occurs across all populations.populations.ShortageShortage of technical and interpersonal competence of technical and interpersonal competence

Future recommandation for quality:Future recommandation for quality:Priorities for future study on qualityPriorities for future study on quality and quality improvement— and quality improvement—particularly the overuse, underuse, and misuse of health care servicesparticularly the overuse, underuse, and misuse of health care services—include:—include:Identify which financial and organizational factors Identify which financial and organizational factors promote quality and promote quality and how different payment methods, financial incentives, and how different payment methods, financial incentives, and organizational factors organizational factors Design and implement new care processes Design and implement new care processes that enable patients to act that enable patients to act as co-managers of their health care, particularly for chronic illnesses.as co-managers of their health care, particularly for chronic illnesses.Identify telecommunications applicationsIdentify telecommunications applications that will enhance patients' that will enhance patients' access to information and patient-provider communication.access to information and patient-provider communication.Identify effective information technology Identify effective information technology tools and systems that alert tools and systems that alert providers in real-time to the critical information they need to provide providers in real-time to the critical information they need to provide safer, high quality care.safer, high quality care.Implement and evaluate strategiesImplement and evaluate strategies to improve quality of care for to improve quality of care for people with disabilities.people with disabilities.Identify and address factors that promote Identify and address factors that promote adoption of promising adoption of promising quality improvement strategies quality improvement strategies (e.g., patient self-management) by all (e.g., patient self-management) by all who would benefit.who would benefit.

WHAT IS HEALT INSURANCEWHAT IS HEALT INSURANCE? ? • SYSTEM OF ASSURANCE TO MAKE CONTINGENCIES OF HEALTH SYSTEM OF ASSURANCE TO MAKE CONTINGENCIES OF HEALTH

CARE EXPENSES.CARE EXPENSES.• TO PROVIDE PROTECTION AGAINST FINANCIAL LOSS BY TO PROVIDE PROTECTION AGAINST FINANCIAL LOSS BY

UNFORSEEN SICKNESS.UNFORSEEN SICKNESS.• TO MEET COST OF GOOD MEDICAL CARE.TO MEET COST OF GOOD MEDICAL CARE.• RELIEVES ANXIETY AND TENSION.RELIEVES ANXIETY AND TENSION.

HEALTH INSURANCEHEALTH INSURANCEHealth Insurance can be broadly defined as a financial mechanism that Health Insurance can be broadly defined as a financial mechanism that exists to provide protection to individual and households from exists to provide protection to individual and households from expenses incurred as a result of unexpected illness or injury.expenses incurred as a result of unexpected illness or injury.Health insurance, which remains highly underdeveloped and less Health insurance, which remains highly underdeveloped and less significant segment of the product portfolios, is now emerging as a tool significant segment of the product portfolios, is now emerging as a tool to manage financial needs of people to seek health services. to manage financial needs of people to seek health services.

The reasons for rise in health care cost are:-The reasons for rise in health care cost are:-Increase in medical treatment costsIncrease in medical treatment costsTechnological advancements in medical equipmentTechnological advancements in medical equipmentHigh labour costs. High labour costs. 

HEALTH INSURANCE IN INDIA & EMERGING SCENARIO OF HEALTH INSURANCE IN INDIA & EMERGING SCENARIO OF HEALTH CAREHEALTH CARE1.Rural Versus Urban Divide: 1.Rural Versus Urban Divide:  India still spends only around 4.2% of its India still spends only around 4.2% of its national GDP towards healthcare goods and services (compared to 18% national GDP towards healthcare goods and services (compared to 18% by the US)by the US)2. 2. Need for Effective Payment Mechanisms:Need for Effective Payment Mechanisms:  According to the World   According to the World Bank and National Commission’s report on Macroeconomics, only 5% of Bank and National Commission’s report on Macroeconomics, only 5% of Indians are covered by health insurance policies. Such a low figure has Indians are covered by health insurance policies. Such a low figure has resulted in a nascent health insurance market which is only available for resulted in a nascent health insurance market which is only available for the urban, middle and high income populations.the urban, middle and high income populations.3. 3. Demand for Basic Primary Healthcare and InfrastructureDemand for Basic Primary Healthcare and Infrastructure:  children :  children under five are born underweight and roughly 7% (compared to 0.8% in under five are born underweight and roughly 7% (compared to 0.8% in the US) of them die before their fifth birthday. For primary healthcare, the US) of them die before their fifth birthday. For primary healthcare, the Indian government spends only about 30% of the country’s total the Indian government spends only about 30% of the country’s total healthcare budget.healthcare budget.4. 4. Growing Pharmaceutical SectorGrowing Pharmaceutical Sector: According to the Indian Brand Equity : According to the Indian Brand Equity Foundation (IBEF), India is the third-largest exporter of pharmaceutical Foundation (IBEF), India is the third-largest exporter of pharmaceutical products in terms of volumeproducts in terms of volume5. 5. Underdeveloped Medical Devices SectorUnderdeveloped Medical Devices Sector:  Recently, the government :  Recently, the government has been positive on clearing regulatory hurdles related to the import-has been positive on clearing regulatory hurdles related to the import-export of medical devices, export of medical devices,

MAJOR CHALLENGES FOR INDIA IN THE HEALTH SECTORMAJOR CHALLENGES FOR INDIA IN THE HEALTH SECTOR

Manpower-Number & NormsManpower-Number & NormsRural/Urban differentialRural/Urban differentialGeographical divide across statesGeographical divide across statesS-E groups-accessibility/reachS-E groups-accessibility/reachGaps between policy and ActionGaps between policy and ActionNewer Infections’Newer Infections’ Lack of trained doctors, physicians & nursesLack of trained doctors, physicians & nursesLack of medical infrastructure Lack of medical infrastructure Health Status and risksHealth Status and risksIssues of malnutritionIssues of malnutritionUnequal distribution of resources & issues of low cost but effective Unequal distribution of resources & issues of low cost but effective medical caremedical careLack of contribution by the society Lack of contribution by the society Even though there is 100% FDI allowed in the health sector, there is Even though there is 100% FDI allowed in the health sector, there is still not enough inflowstill not enough inflow

CONCLUSION:CONCLUSION:The Indian health sector can be viewed as a glass half empty or a glass The Indian health sector can be viewed as a glass half empty or a glass half full. The challenges the sector faces are substantial from the need half full. The challenges the sector faces are substantial from the need to improve physical infrastructure to the necessity of providing health to improve physical infrastructure to the necessity of providing health insurance & earning the available of trained medical personnel. insurance & earning the available of trained medical personnel. Health care is only one determinant of health outcomes; good health is Health care is only one determinant of health outcomes; good health is also a result of better nutrition, safe drinking water and sanitation, also a result of better nutrition, safe drinking water and sanitation, universal access to education, gainful employment, better working and universal access to education, gainful employment, better working and living conditions, control over addictions as well as environmental living conditions, control over addictions as well as environmental pollution (both material and cultural), the elimination of various forms pollution (both material and cultural), the elimination of various forms of discrimination, and equitable and inclusive development. Fair, of discrimination, and equitable and inclusive development. Fair, accessible, affordable and public universal health care will not happen accessible, affordable and public universal health care will not happen overnight in India.overnight in India.We concede that universalizing the health insurance is not the sole We concede that universalizing the health insurance is not the sole answer to India's health system problems. it offers opportunity to answer to India's health system problems. it offers opportunity to improve quality of private and the public sector through accreditation improve quality of private and the public sector through accreditation system. Finally, the scheme has a potential to strengthen the public system. Finally, the scheme has a potential to strengthen the public healthcare system by a carefully designed incentive system for public healthcare system by a carefully designed incentive system for public sector providers and improving infrastructure.sector providers and improving infrastructure.

CONCLUSION:CONCLUSION:

Growth potential for the insurance sector is immense.Growth potential for the insurance sector is immense. Consideration required to poor & unemployed.Consideration required to poor & unemployed. Private health insurance has positive role to play.Private health insurance has positive role to play. Insurance sector needs to widen its scope from only providing Insurance sector needs to widen its scope from only providing

treatments facilities to promote & preventive health care. treatments facilities to promote & preventive health care. India lags behind in the key healthcare indicatorsIndia lags behind in the key healthcare indicators Inadequate & poor healthcare planningInadequate & poor healthcare planning Inequitable distribution of resources b/w states as well as urban Rural Inequitable distribution of resources b/w states as well as urban Rural

settingssettings Low insurance penetrationLow insurance penetration Increase concentration on health & education Increase concentration on health & education Encourage participation of society towards health sector.Encourage participation of society towards health sector.

THANK YOUTHANK YOU