Category: Healthcare Finance

Neuro and Spine

Differences between Healthcare Systems of India and the UK

Continuing with our series on comparison of Indian healthcare system with various healthcare systems across the  globe, here are some gross differences.

The Indian healthcare system, though evolved from its colonial roots of the British empire, started with many similarities but has not been able to maintain the strength of its public arm and consequently the private arm has far overtaken and established deep roots in the Indian healthcare scenario.

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UK:
A healthy proportion of 9.6% of the GDP is spent towards healthcare expenditure.Public spending contributes to 81.7 percent of overall healthcare expenditure.

India:
4.1% of the GDP is spent on healthcare expenditure while the public spending is as low as 1.2% of the GDP or 26.2% of the total expenditure(2010).

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UK:
Healthcare is publicly funded from general taxation, and is free to all permanent residents.There is also a thriving private healthcare sector which is considerably smaller than its public equivalent. The cost of private healthcare is mainly covered via private health insurance.

India:
Majority of healthcare expenses are out of pocket with private sector playing a major role. There is no single universal scheme covering the entire population. Though there are a multitude of health benefit schemes at central and state level for specific sections within the population.


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UK:
Fifteenth best in Europe and eighteenth in the world (amongst 191 member states in the World Health Report, 2000)

India:
Ranked at 112 in the world (amongst 191 member states in the World Health Report, 2000)

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UK:
Coordinated care is a norm. For elective care, patient has to visit a General Practitioners (GPs) first who acts as a referral authority for referral to specialists and super-specialists as necessary.

India:
Coordination of care is weak, almost non existent. Anybody can directly approach any specialist or super-specialist without proper referral system in place.

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UK:
Single holistic health services under National Health Services(NHS) England cover entire spectrum of primary to tertiary healthcare, acute to chronic services and vaccination to adult screening programs.

India:
Multiple centre and state level programs which cover same issues amongst the same set of beneficiaries on one end. For instance, maternal health has schemes such as Janani Shishu Suraksha Karyakram (JSSK), Janani Suraksha Yojna (JSY)  and Indira Gandhi Matritva Sahyog Yojna (IGMSY) running in parallel apart from innumerable schemes in every state. On the other hand there is no focus on other set of health issues like geriatric health.

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UK:
Pharmacies (other than those within hospitals) are privately owned but have contracts with the NHS to supply prescription drugs. Systematic and only on prescription sale of drugs is the standard practice.

India:
Pharmacies are predominantly privately owned by single owners with no affiliation to public health systems except for licensing
formalities. There is indiscriminate sale of drugs over the counter including antibiotics leading to a very imminent risk of widespread bacterial resistance

The Arogyada
www.arogyada.in
January 17, 2014 / by drsandeep.net

Five Key Challenges for Indian Health Insurance Industry

In the current scenarios Indian health insurance industry can be considered to still be in its infancy. The next few years posit a plethora of challenges. Have highlighted key five areas of concern.

1. Lack of standardised transactions between the insurer and hospitals or the insurer and insured. This often results in individual interpretation and methodology for processes like claims and pre-authorization

2. Use of non-standard terminologies with regards to treatment protocols and care plans. In fact absence or minimal documentation and implementation of standard care pathways become a cause of conflict with regards to services covered/not covered for payment via the insurer. This gets further aggravated with extremely poor usage and implementation of ICD codes

3. Skewed penetration (much higher in urban India than rural) of private health insurers within the Indian population leading to asymmetric distribution of risk. This ultimately on one hand bleeds the insurer, on other hand hits the insured due to higher premiums and finally also the hospitals due to higher rejection rates

4. Non SLA based transactions between hospitals and insurers. Response time and request closure time for crucial transactions like pre-auth filling, pre-auth approval, claim filling, and claim approval is still not a strictly followed dimension.

5. Both hospital and insurer hold sensitive patient data but we are still far from having any form of implementable India specific law or guidelines to protect and securely exchange patient data between two major pillars of healthcare industry

The Arogyada
www.arogyada.in
January 8, 2014 / by drsandeep.net