1. UNIVERSAL HEALTH COVERAGE- TAMILNADU-ROLE OF INSURANCE
POPULATION
India Mn
Tamil Nadu Mn

2. Outline What is Universal Health Care /Coverage(UHC)
How does Tamil Nadu fare in achievement of UHC currently
What are the possible models for UHC and role of insurance
Challenges and opportunities for the future

3. Universal Health Coverage (UHC)
World Health Organization
28 December, 2018
Universal Health Coverage (UHC)
The goal of universal health coverage (UHC) is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
Basic requirements of UHC
A strong, efficient, well-run health system that meets priority health needs
Affordability – a financing system to avoid financial hardship
Access to essential medicines and other health technologies
Sufficient capacity of well-trained, motivated health workers to provide the services needed
Resources are scarce in all settings and forms of priority setting are inevitable
WHO has a commitment to supporting member states as they move towards universal health coverage. An important dimension of UHC is providing access to essential medicines and health technologies. Making sure that quality assured essential medicines are available requires properly functioning pharmaceutical systems.

4. Three Dimensions to Consider When Moving Towards Universal Coverage

5. How does Tamil Nadu fare –based on the 71st Round of NSSO Survey on Social Consumption-Health
Morbidity profile based on self reported ailment status
Utilization of health care in public and private system
Inpatient and outpatient expenditure in public and private system

6. Proportion of population reporting chronic, other and/or all ailments during the reference period of last 15 days in Tamil Nadu – 2014
Ailment type
Rural
Urban
Rural + Urban
Chronic 86
119
103
Other ailment 63 71 67
All ailing
146
184
165
Since the differences in reported morbidity prevalence levels by selected background factors will indicate the unequal burden of morbidity in the population, an attempt is made to examine the differences in morbidity levels by individual characteristics as well as household socio-economic characteristics. (Rural/Urban), (Gender, Age, Expenditure Quintile)

7. Percentage distribution of reported disease conditions (Top 10) among all ailing persons (15 days recall)_2014
Males report significantly higher share in comparison to women— diabetes (30.1% versus 21.8%) and respiratory diseases (12.2% versus 8.9%). Women have higher reporting of musculo-skeletal ailments (13.5% in women versus 6.6% in men), mental health problems (6% in women versus 2.3% in men) and genito-urinary ailments (2.4% in women versus 0.6% in men)

8. Trend in % episodes (15 days recall) treated in formal care in TN and All India in , 2004 and 2014

9. Percentage of population utilising healthcare as outpatient and inpatient – All India and Tamilnadu
Notes: 1. Outpatient and hospitalisation (15days recall) are not mutually exclusive; 2. Hospitalisation with 365 days recall includes hospitalisation with 15 days recall; per 1000 population.

10. Percentage distribution of all treated outpatient episodes by level of care in rural, urban and rural + urban in Tamil Nadu– 2014
Level of care
Rural
Urban
Total
HSC/ANM/ASHA/AWW
1.5
0.3
0.8
PHC/dispensary/CHC/mobile medical unit
10.3
3.4
6.4
Public hospital
30.6
24.9
27.4
Private doctor/clinic
19.9
27.8
24.4
Private hospital
37.8
43.4
41.0
Note: Including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH); excludes outpatient utilization for childbirth and post hospitalization outpatient visits.

11. Percentage distribution of all inpatient episodes by levels of care in Tamil Nadu and All India – 2014
 Level of care
Tamil Nadu
All India
Rural
Urban
Total
PHC/dispensary/CHC etc.
1.65
0.54
1.08
4.9
1.21
3.61
Public hospital
38.74
28.72
33.55
36.98
30.82
34.82
Private hospital
59.61
70.74
65.37
58.12
67.97
61.57
100
Note: Excludes hospitalization due to childbirth.

12. Average out of pocket per OP visit and per hospitalisation case (per admission): medical expenditure (Rs.) and non-medical expenditure (Rs.)
Type of expenditure
Public sector
Private sector
Public + Private
Out-patient
Medical 40
603
406
Non-medical 50 94 79
Total 90
697
485
In-patient
600
27228
18006
1816
2456
2234
2416
29684
20240

13. Per person monthly out-of-pocket expenditure (Rs
Per person monthly out-of-pocket expenditure (Rs.) on outpatient, inpatient and total in Tamil Nadu – 2014
Sector
Outpatient
Inpatient
Total
Rural
114 63
177
Urban
190
128
318
152 95
247
Notes: 1.Excluding childbirth episodes. 2. Out-of-pocket (OOPE) expenditure are estimated after deducting any cash insurance reimbursement. Any cashless reimbursement is not considered as part of the OOPE.

14. Percentage population reporting coverage under different schemes for financial support to meet expenditure in Tamilnadu, 2014

15. Share of public and private sectors in total hospital care utilisation by Socio-economic groups in Tamilnadu, 2014

16. Why UHC- Do we not have a universal public health care system
Coverage: Though 90% of those ailing sought formal care in the state, only roughly 35% of outpatient and inpatient care is utilized in public sector. We do not know who is left uncovered.
Services covered: Growing burden of Chronic and Non communicable diseases. Existing focus of public system only for RCH services. No defined Essential Health Package (EHP).
Financial Protection : Out of pocket expenditure in public system lower than private system. Existing insurance scheme does not address costs of outpatient care. Very low awareness of insurance coverage

17. Role of insurance for achieving UHC
Guiding principles for UHC by WHO
reduce direct payments,
maximize mandatory pre-payment
establish large risk pools
use general government revenue to cover those who cannot afford to contribute….
Sounds just like a insurance programme .. Or does it??

18. Alternate approaches to UHC- Successful models
Tax financed UHC models- Entire health system is directly publicly funded-Brazil and Sri Lanka
Pooled insurance type schemes- insurance premiums from collected from those in formal salaried employment and pooled with tax revenue to finance health coverage for the entire population.- Thailand , Krygistan

19. Some basic features of Thai UCS
The UCS, with its overarching goal of an equitable entitlement to health care for all Thais, has three defining features:
a tax-financed scheme that provides services free of charge (initially, a small copayment of 30 baht or US$ 0.70 per visit or admission was enforced, but this was terminated in 2006)
a comprehensive benefits package with a primary care focus, including disease prevention and health promotion;
fixed budget with caps on provider payments to control costs.
Three major conditions for UHC schemes to succeed:
Extension of access to services, cost containment and strategic purchasing.

20. Challenges and opportunities for the future
Expand the existing government funded insurance scheme to achieve more coverage
Adopt and adapt the Central Government insurance scheme to provide better access and more financial protection to the people by strengthening the public system
Develop a system of responsive resource allocation for the public sector through these funding schemes
Build a system of oversight to regulate the costs and quality in the public and private sector.