Page 20 - Insurance Times August 2019

live is giving rise to another devil in the making-doctors who primarily out of pocket expenses. If comprehensive
themselves need medical help for depression and healthcare is the goal, effective financing and delivery of
psychological conditions. primary healthcare is vital. Setting up of 1,50,000 health and
wellness centres is a big initiative and it has to be primarily
The Resident Doctors Association of AIIMS, Delhi, reported implemented effectively. There is a strong case for public
that at least half-a-dozen doctors checked themselves into private partnership in establishing and running these health
the psychiatric ward since January this year. Depression is centres with specific measurable goals.
also rampant in the nursing community due to taxing work
hours, emotional stress, and more recently, cases of verbal Private participation could be further encouraged by means
abuse and manhandling by patients and their kin. It is well- of tax benefits or subsidies. Hospitals that are empanelled
established that the hostility and distrust of patients under the health protection scheme should be graded
towards health workers is a result of strong-rooted according to their infrastructure available and quality of care
frustration built up over years of dealing with a crippled and provided, and then continuously monitored also. The
exhausting public health system. government must set up a National Health Regulatory
Authority and insist on all state governments to set up
In the private sector, finding access to a trained physician similar authorities. All the heads of such regulatory
is a matter of luck and economic status. For a city-dweller authorities should become members of the National Health
seeking consultation from a private practitioner, say in Delhi, Regulatory Authority. This would bring in uniformity in the
there is a 40% chance that one's doctor may not hold a healthcare sector in the country.
medical degree. The odds of meeting a degree-less,
allopathic-doctor-by-experience go up to as much as 70-80% Every NHPS beneficiary should mandatorily register with
in states of Uttarakhand, UP, Bihar and Jharkhand. one of the wellness and health centres, which can function
on capitation basis. To avoid unnecessary usage, a nominal
The problem of big numbers: co-payment can be collected from beneficiaries when such
facilities are used. Medicines and diagnostics can be
India has the problem of big numbers. Just launching NHPS
provided at subsidized prices or free to those who cannot
without integrating the wellness centres as well as the
afford it. These centres-manned by Primary Care Physicians
government infrastructure may not yield the desired result
in the long run. We must realize that implementation of (PCPs)-will provide outpatient care, including diagnostic
such schemes requires strong planning, strong regulations, facilities and medicines, and also act as gatekeepers for
NHPS.
simple and efficient processes, and continuous monitoring
through the use of advanced technological platforms.
Polyclinics with specialists and higher level of diagnostic
facilities should also be established for referrals from the
Implementation failures can not only result in an
exponential rise in costs of such schemes, but also put a primary centres. Every beneficiary of NHPS should consult
strain on future allocations as well towards the healthcare a PCP in the health and wellness centre, and treatment in
polyclinic by a specialist would be only on referral from the
sector. Studies indicate that 65% of the healthcare
primary centre. Existing as well as the new district hospitals
expenditure in the country is for outpatient care, which are
should be equipped to be on par with corporate tertiary
care hospitals. Existing as well as new medical college
hospitals should be equipped to be on par with corporate
super specialty hospitals. Admissions of any NHPS member
to a hospital should be only on referral from the PCP or the
specialist, except in emergencies such as accidents.

The PCPs and the specialists will act as gatekeepers for
hospitalizations and would be responsible for preventing
unnecessary hospitalizations and surgeries. Suitable
mechanisms have to be built to prevent collusion of PCPs
and specialists with hospitals. India needs to do a lot more
on infant mortality and unequal access to medical care. The

20 The Insurance Times, August 2019