Healthcare, with global revenue of over Rs.2.75 trillion is the largest industry in the world. Where does India stand against the new disease management practice in health insurance in developed countries?
The nation of India with a population of 1000 million experiences a vast inequity that exists in the healthcare industry with barely 3 per cent of the population covered by some form of health insurance, either social or private. The guiding principle of Bhore Committee in 1946 that 'no individual should fail to secure adequate medical care because of inability to pay for it' looks unreachable still, after 50 years of Indian independence.
In India, presently the health insurance exists in the form of Mediclaim policy offered to the individual or to any group, association or corporate bodies. Penetration of Mediclaim is currently done by state-owned insurance companies, covering only about 2.5 million people i.e. less than 0.50 per cent of the country's population.
The primary health care system in India is managed mainly by the shallow structure of government health-care facilities and other public-health care systems in a traditional model of health funding and provision. But, it is unable to justify the demand for health security for 200 million Indian health insurable population mainly due to service costs being out of the reach of many people, absence of good and effective number of physicians, low rate of education programs, less number of hospitals, poor medical equipment and over all, the poor budget of government towards the health program.
Even Social insurance schemes available in India, such as the Employee State insurance Scheme (ESIS) and Central Government Health Scheme (CGHS) have restricted coverage to a very small segment of the population, around 3 per cent.
Therefore, the health insurance policy in India is nothing but a burden of inefficiency of a government run system. Moreover, the uncontrolled and no-innovative attitude of Indian bureaucracy always argued against the private players in the health insurance sector in India.
Indian government has never been sensible to understand that the opening of insurance sector in India will move individual health spending to a collective spending backed by a huge capital inflows into the health industry. The existing limited medical coverage and inefficient administration is likely to be demolished by the increasing service efficiency. Furthermore, the intermediaries like service providers, health management organizations, preferred provider organizations and third party administrators would not only assist in increasing the coverage, but would also improve the quality of the system - the transition of health care from curative to managed care - the disease management as practiced by developed countries.
At its best, disease management is neither a turf protector for specialists nor a marketing vehicle for drug companies. It's a common-sense approach to unifying care for a condition, and it depends on primary care physicians. In other words, disease management is a way to reduce the cost of Health Maintenance Organization (HMOs) and Preferred Provider Organizations (PPOs) in developed countries, more specifically in United States that sharpens the Managed Care plans of health insurance sector. Managed Care plans are so popular in the US that they now employ more than 70 per cent of all the physicians in the country.
Notably, when Disease management decides the profit of insurers by constructing a system of care for a particular condition such as asthma, diabetes or cholesterol, that is intended to reduce costs and improve outcomes, Managed Care is a step ahead of traditional insurance system assuring quality into the system. Disease management means more teamwork between primary care physicians, sub-specialists and non-physician providers. Thus in a disease management program, health plans and physicians attempt to identify patients who would benefit most from intense prevention and treatment protocols. Managed Care, in-turn ensures out-of-pocket costs, are generally lower, and there is far less (if any) paperwork for plan members to contend with.After comparing this systematic, quality packed, value-added health system with Indian health insurance sector, it is clearly understood, we have a far way to go to touch the global health insurance wave. Replacement of the existing system will hardly do anything, unless a conscious revolution comes with private players in this sector. And "The first duty of a revolutionary is to get away with it". What do you say - time for our government to play revolutionary?