001a leela mhm us uk hlth care sys 24 sep 2014
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Transcript of 001a leela mhm us uk hlth care sys 24 sep 2014
INDIA, US & UK HEALTH CARE SYSTEMS
A SMALL BRIEFB LEELA DHARMDHM (OU) 2014-16; AIHAROLL NO 1404-01-676031(INDIA)94904-68518; [email protected]
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.
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
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)
TO ACQUAINT THE CLASS WITH THE
HEALTH CARE SYSTEMS OF US & UK AND REVIEW THEM
WITH REFERENCE TO OUR INDIAN HEALTH
CARE SYSTEM
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
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 – 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).
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.
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.
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.
SPECIAL THANKSYOU ALL AUDIENCE FOR LISTENING TO ME
WITH PATIENCE
PROF AYYAPPU REDDY FOR GIVING ME AN EXPOSURE & OPPORTUNITY
TO DELIVER THIS TOPIC
THANKS
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