1. Financial sustainability – Questions for future
Dr.P.Umanath IAS

2. Financing of health sector and insurance based health care schemes in States
Present – state funded and private
Question of 6% of GDP ?????
Existing Tax – GDP ratio
Fixed expenditure vs Schemes
Split in terms of Union and States
Predominantly states
Union funding under schemes

3. Fiscal implications and share of insurance model in sector expenditure
Tamil Nadu context
High social sector investments
Sectoral expenditure trend since insurance model was introduced
From 2700 crores to 9000 crores
Comparative trends in insurance costs
Share in overall costs vs. outputs

4. Sectoral expenditure & supplementary role play by various players
Government institutions – increasing role
Public investments for that role within the sectoral expenditure
Machinery and equipment / Drugs
270 crores to 570 crores
Diagnostics - TNMSC
Role of various levels – are investments proportionate ?

5. Financial utility of non-insurance models and their functional sustainability
Status Quo – Public Sector approach
Trusts versus Insurance model
Loaded costs – taxes, interest and overheads
Quantifying alternatives
Taxation trends – present and future
Functional efficiency trade off
Role of conflict of interests
Criticality of avoiding convergence of interests among players

6. Choices in investing public resources for better health outcomes
Need to go by outputs rather than demands
Collateral benefits vs. core objectives
Easier availability vs. high end delivery
Volumes vs. quality
Is parallel strengthening needed ?
Transport and communication
User choice

7. Long term effect of health insurance on the premium cost
Crucial variables
Claim trends
Coverages – numbers and verifiability
Cost management by hospitals
Beds added and competition
Bed occupancy and share of scheme in it
Fixed costs and added running costs
Need to focus on ‘critical nature’

8. Cost Benefit Analysis Data shows clear divergence
Volume play - public sector
Complicated play – private
Sole objective or wider compromise
Variable situations
Developed and non-developed delivery situations
Early stages - public sector crucial, irrespective of deficient output
Later stages – selective strengthening approach

9. THANK YOU