Meet discusses ways to keephealth-care cost low

Health insurance may not be the answer to the spiralling health-care costs in the State.

Keeping health-care costs down while ensuring social health protection coverage for all sections of society is going to be a tough challenge that the State will have to tackle, health economists and public health activists have pointed out.

At a national consultation on ‘Kerala Health Financing Strategy: Vision, Goals and Design,' held here on Thursday, health economists pointed out that while all existing social health insurance schemes typically focussed their attention on providing coverage for hospitalisation expenditure, the fact remained that out-patient clinic expenses, costs of drugs and lab diagnostics accounted for over two-third of the out-of-pocket expenditure on health. The event was co-hosted by Health Systems Research India Initiative, an initiative launched by a group of young public health professionals to provide health system research inputs for policy-makers, and the Health Economics Association of India.

“People are being impoverished by the out-of-pocket expenditure on OP care and drug costs, yet none of the insurance schemes seem to be able to reduce this household costs on health care in Kerala.

When it comes to health outcomes, social health insurance schemes do not seem to be doing any better than tax-based health financing,” Shaktivel Selvaraju, health economist, Public Health Foundation of India, New Delhi, pointed out.

The high burden of non-communicable diseases, aging population, and increasing use of technology in health care were some of the factors pushing up the health-care costs in the State.

The proliferation of super-specialty hospitals in the private sector in the State indicates that a lot of money is being spent on secondary and tertiary care as well and that there is an increasing demand for such facilities.

This high demand is partly due to the increasing burden of non-communicable diseases as well as the failures within the public health system to meet the people's demand, said Gita Sen, Professor, Indian Institute of Management, Bangalore.

As far as social protection in health is concerned, an integrated framework for health care should be developed in which the tertiary care sector does not consume all the costs, Dr. Sen said.

Dr. Sen, a member of the High Level Expert Group (HLEG), set up by the Planning Commission in October 2010 to look at the provision of Universal Health Coverage, said the HLEG has recommended that while strengthening the public health system should be the bedrock on which social health protection schemes should be based, the goal of universal health coverage can be achieved only by acknowledging that the private sector has a definite role to play.

HLEG has, among its recommendations, suggested that the system move forward from ad hoc, unregulated public-private partnerships to a strong regulatory framework to incorporate private contracted services in health care coverage.

The fiscal viability of and experiences with one of the existing social health protection schemes, Rashtriya Swasthya Bima Yojana (RSBY), was widely discussed at the meeting.

Earlier, inaugurating the seminar, Vice-Chairman of the Kerala State Planning Board K.M. Chandrasekhar said the State had to look at innovative ways in which the heath needs could be financed because social health protection was a requirement for not just the poor but the rich and the middle class also.

He pointed out that with an aim of providing universal health coverage, in the 12{+t}{+h}Plan, the Government of India was looking at an investment of about Rs.22,000 crore in RSBY to extend the health cover from BPL to the entire population.

While this would ensure a baseline health coverage for all, it is also necessary to build in specific schemes for meeting specific needs within the basic framework, Mr. Chandrasekhar said.

Health Secretary Rajeev Sadanandan; D. Varatharajan, health economist, WHO; P.K. Jameela, Director of Health Services; Gautam Chakraborty, Ministry of Health and Family Welfare; among others, took part in the discussions.


  • Integrated framework for health care mooted

  • Private sector has role to play in ensuring universal coverage


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