1. Health Financing Reforms in India Linking to Africa
July 9, 2015

2. Health Financing in India: The Landscape
Outline
Health Financing in India: The Landscape
Current Reforms and Practices in India
Synergies and Relevance to Africa
Health Financing Support Program
About ACCESS Health
Core Functions of Health Finance Support Program (DFID Supported)
Emerging themes and Potential Linkages
The way forward 2

3. 28 states, 7 union territories Population: 1.25 billion
Background: India
28 states, 7 union territories
Population: 1.25 billion
29% of population urban, 71% rural
Lower-middle income country
GDP Per Capita 1,498 US$
270 million people below-poverty-line 4

4. Life expectancy at birth: 66 years
Health Indicators
Life expectancy at birth: 66 years
Infant mortality (per 1,000 live births): 58
Child malnutrition (% of children under 5): 44
Under-5 mortality rate (per 1,000 live births): 72
Maternal mortality ratio (per live births): 450
Hospitalization: 2.5 per 100 population
Out patient care: 0.5 incidence per person per year 5

5. Low Public Expenditure and high OOP payment
High OOP payment AT THE POINT AND TIME OF USE! 6
Source: Ministry of Health & Family Welfare. National Health Accounts, India. New Delhi, 2009

6. Strategic options High OOP Limits Access
Improve access
Abolish user charges and improve public health facilities
High OOP
Increase in poverty
Reduce tax base
Low allocation for health sector
Variable Standards of public services & high use of private health providers
Limits Access
Health Insurance covering private provider
Reduce poverty
Increase allocation to health sector
Increase tax base 7

7. Options chosen by government
Improve access
Abolish user charges and improve public health facilities
Reduce Access
High OOP
Increase in poverty
Reduce tax base
Low allocation for health sector
Dysfunctional public services & high use of private health providers
Health Insurance (RSBY)
Reduce poverty
Increase allocation to health sector (NRHM)
Increase tax base 8

8. National Health Insurance Scheme (RSBY)
Claims
&
Reimbursement
(smart card)
Registration fee –
Rs 30
BPL families
BPL Families
(37M Families)
Public and Private
Providers
CARE
Hospitalisation
expenses
Select day care procedures
Max
$667
family floater
Transportation costs
Max $2.5 per trip and totally $25
Pre -
hospitalization
(1 day) & Post
hospitalisation
(5 days) expenses
Minimum exclusions
Insurance company
Central government
State government
Premium
75%
25%
started in the year 2008;
Source: N. Devadasan et al. Rashtriya Swasthya Bima Yojana: an overview. IRDA journal (2008) 9

9. Health Financing Reforms in India
Policy Practices
Public financing for Health through Insurance
Universal Health Coverage:
Increasing geographic and population coverage
Engaging Private Sector and designing innovative PPP models
Developing Primary care integrations models
Implementation Practices (supply and demand side)
Enrolment: Use of Smart card technology
Designing package rates and costing studies
Claims: Review and Data Monitoring 10

10. Successful Innovations
Use of information technology in Aarogyasri allowing for online payments (faster than managed in the US)
Pre authorization with medical experts reviewing diagnosis before guaranteeing reimbursements to MANAGE FRAUD,
Ongoing analytics to identify fraud and improve the program (e.g. introduced guidelines for hysterectomies) 11

11. ACCESS Health International
A non-profit think tank and advisory group
Dedicated to improving access to high quality, affordable healthcare in low, middle, and high income countries
Advise national and regional governments and the private sector on the design and management of healthcare finance and delivery systems 12

12. Quality Access To improve health outcomes
Health Financing Support Program
WHAT
To improve health outcomes
HOW
By ensuring better use of public funds
Access
Financial and geographic
Quality
Improved accountability
WHY
For improved equity and effectiveness in the health system
As per the Draft National Health Policy 2015, less than 20% of primary health care needs are addressed in the public sector 13

13. Health Financing and Support Programme
Information Hub for Health Financing
Designed to support better use of secondary data to inform decision makers on reform progress on an ongoing basis.
On-demand Support Fund
Builds peer to peer linkages between the increasing numbers of experienced professionals in India and representatives from countries designing and implementing health financing reforms.
Complements ongoing activities
Linking activities of PPP and primary healthcare models.
aligned with other international activities under the Joint Learning Network. 14

14. Health Financing & Integration with Primary Health Care, Quality & Public Private Collaboration in Health 15

15. Snapshot of the Program
Investments, technology and innovations 16

16. Management and Payments
Functional Model
The three core functions of Governance, System Management and Performance Monitoring are separated in our model to increase accountability for improved access and health outcomes
GOVERNANCE (Led by Government)
State and district level governance to ensure effective leadership and execution of:
Stewardship
Contracting /
Procurement
Monitoring
Finance
SYSTEM MANAGEMENT (Independent agency/ Consortium)
PERFORMANCE MONITORING (Third-party agency)
An autonomous agency that ensures data driven decisions through:
Monitoring
Quality
Verification
Audits
Outcome measurement
Research studies
Community Engagement
Service Delivery
Management and Payments
CHC
Performance-linked payments and block-level capitation
PHC or equivalent
PHC or equivalent
Integrated information technology, including patient records
Existing public clinics upgraded to offer a broader, comprehensive range of primary care (e.g. NCD), and drugs and diagnostics in Hub and Spoke model
Pro-active, universal registration and screening of families to ensure access and awareness
Community feedback and grievances collected
Quality assurance through clinical protocols and training
Family Health Teams set up for task-shifting and coordination of care
Private providers contracted to fill gaps
Focus on outcomes, with tracking and reporting of data 17

17. Value Proposition for Governments and Private Sector
MARKET INTELLIGENCE
Trusted Advisor
Policy Reforms
Center of Competency
Structured processes for PPP Lifecycle
Capacity Building and Handholding
Facilitator
Active communication of opportunities
Match opportunities to private innovations and ideas
Orient private sector for government engagement
GOVERNMENT
PRIVATE SECTOR
Partnering for Progress Initiative
OPPORTUNITIES
DATA
Information Repository 18

18. Costing of Health Services
Health Financing Support Program
Emerging Technical Areas for collaboration (connecting with emerging themes in workshop)
Private Sector Integration including primary care, public private partnerships and Quality of Care
Costing of Health Services
Performance Review and Data Monitoring (e.g. claims)
Capacity Building by peer-peer knowledge sharing across countries
Integrated Knowledge Hub 19

19. Step2: Present a portfolio of solutions and expertise in India
The Way Forward
Step 1: Understand the current reform efforts and priorities (e.g PPP Policies and Guidelines, etc)
Step2: Present a portfolio of solutions and expertise in India
Step 3: Study visit to India
Step 4: Jointly develop a work plan for the Collaboration 20

20. Thank you Key Contacts Siddhartha@accessh.org Bhavesh.Jain@accessh.org
Thank you 21