UMA K Assistant Professor in Commerce Mysore The issues and challenges in the role & performance of quality health care in India

1. ROLE & PERFORMANCE OF
QUALITY HEALTHCARE IN INDIA

2. ROLE & PERFORMANCE OFROLE & PERFORMANCE OF
QUALITY HEALTHCARE INQUALITY HEALTHCARE IN
INDIAINDIA
UMA K
LECTURER IN COMMERCE
GOVT. FIRST GRADE COLLEGE,
KUVEMPUNAGAR
MYSORE.
11th
, september 2015, JSS COLLEGE FOR WOMEN,MYSORE.

3. HEALTH IS A HUMAN RIGHTHEALTH IS A HUMAN RIGHT
ITS AFFORDABILITY & ACCEPTABILITY HAS TOITS AFFORDABILITY & ACCEPTABILITY HAS TO
BE ASSURED FOR URBAN A/W/A RURAL, WELLBE ASSURED FOR URBAN A/W/A RURAL, WELL
TO DO TO THE POORER SECTION OF THETO DO TO THE POORER SECTION OF THE
SOCIETY.SOCIETY.
Introduction :Introduction :
Health care delivery has become one of the most significantHealth care delivery has become one of the most significant
economic and political issues of the 1990s. With attempts to restructureeconomic and political issues of the 1990s. With attempts to restructure
the industry for the 21st century come important implications for thethe industry for the 21st century come important implications for the
marketing of health services. In India uninsured and low-income adultsmarketing of health services. In India uninsured and low-income adults
experience substan-tial health and health care inequities when comparedexperience substan-tial health and health care inequities when compared
with insured and higher-income individuals.with insured and higher-income individuals.
The role and the importance of health care systems in the quality of lifeThe role and the importance of health care systems in the quality of life
and social welfare in modern society, have been broadly wellrecognized.and social welfare in modern society, have been broadly wellrecognized.
Health Care scenario:Health Care scenario:
•Before independenceBefore independence - dismal condition.- dismal condition.
•High morbidity, mortality and Infectious diseases.High morbidity, mortality and Infectious diseases.
•After independence - emphasis on PH care.After independence - emphasis on PH care.

4. Present Problem:Present Problem:
•High mortality, negligible MCH care.High mortality, negligible MCH care.
•Urban-Rural divide:70:30.Urban-Rural divide:70:30.
•Population Size of the country.Population Size of the country.
•Declining funds to HealthCare Sector-CG/State.Declining funds to HealthCare Sector-CG/State.
Literature review:
In 19th
century: The root of Quality assurance initiatives in healthcare
Florence Nightingale’s as far back
In1913: The American College of Surgeons(ACS) was founded great
variations in the quality of healthcare
By 1917 and 1930: The ACS developed the Hospital Standardization
process
By 1992: The American Society for Quality (ASQ) healthcare played
role of improving healthcare quality
By 1997: Quality Councilof India(QCI) was established as an
autonomous body-National Accreditation broad for Hospitals and
healthcare providers (NABH)

5. What to expect from healthcareWhat to expect from healthcare ??
Fundamentally, delivery of healthcare should be:Fundamentally, delivery of healthcare should be:
SafeSafe
EffectiveEffective
Patient-centeredPatient-centered
TimelyTimely
EfficientEfficient
AccessibleAccessible
Equitable &Equitable &
Consistent with good outcomesConsistent with good outcomes
Tracking…Tracking…
RegulationRegulation
CitificationCitification
Accreditation & CredentialingAccreditation & Credentialing
Grading/ RatingGrading/ Rating
Quality AwardsQuality Awards
……..and Others???..and Others???

6. INDIAN HEALTH CARE SCENARIOINDIAN HEALTH CARE SCENARIO
 Unequal distribution of healthcare resourcesUnequal distribution of healthcare resources
 Lack of strict regulationLack of strict regulation
 Rising costsRising costs
 Wide inequality in healthcareWide inequality in healthcare
 Gender inequalityGender inequality
 High cost of imported equipmentHigh cost of imported equipment
 Change from govt. sector domination to private sector in the last 20Change from govt. sector domination to private sector in the last 20
yearsyears
 Large affordable middle classLarge affordable middle class
 Medical tourism on the riseMedical tourism on the rise
 Revolution in India over the last decadeRevolution in India over the last decade
 Increasing public awareness & private investments in healthcareIncreasing public awareness & private investments in healthcare
 Complicated cases used to go to govts. teaching hospitals.Complicated cases used to go to govts. teaching hospitals.
 Achievements in quality in many hospitals on par with westernAchievements in quality in many hospitals on par with western
standardsstandards

7. AIMS & ROLES OF HEALTHCARE SERVICES FOR IMPROVEMENTAIMS & ROLES OF HEALTHCARE SERVICES FOR IMPROVEMENT
There were identified 9 aims for improvement in healthcare services theyThere were identified 9 aims for improvement in healthcare services they
are:are:
1.1. Safe:Safe: avoiding injuries to patients from care that is intended to helpavoiding injuries to patients from care that is intended to help
them.them.
2.2. Effective:Effective: providing services based on scientific knowledge to all whoproviding services based on scientific knowledge to all who
could benefit, and refraining from providing services to those unlikelycould benefit, and refraining from providing services to those unlikely
to benefit (avoiding underuse and overuse).to benefit (avoiding underuse and overuse).
3.3. Patient-centered:Patient-centered: providing care that is respectful of and responsive toproviding care that is respectful of and responsive to
individual patient preferences, needs, and values and ensuring thatindividual patient preferences, needs, and values and ensuring that
patient values guide clinical decisions.patient values guide clinical decisions.
4.4. TimelyTimely: reducing waits and sometimes harmful delays for both those: reducing waits and sometimes harmful delays for both those
who receive and give care.who receive and give care.
5.5. Efficient:Efficient: avoiding waste, such as waste of equipment, supplies, ideas,avoiding waste, such as waste of equipment, supplies, ideas,
and energy.and energy.
6.6. Equitable:Equitable: providing care that does not differ in quality because ofproviding care that does not differ in quality because of
personal characteristics such as gender, ethnicity, geographicpersonal characteristics such as gender, ethnicity, geographic
location, and socioeconomic status.location, and socioeconomic status.

8. 7.7. Better Care:Better Care: Improve the overall quality, by making health care moreImprove the overall quality, by making health care more
patient-centered, reliable, accessible, and safe.patient-centered, reliable, accessible, and safe.
8.8. Healthy People/Healthy Communities:Healthy People/Healthy Communities: Improve the health of the India,Improve the health of the India,
population by supporting proven interventions to address behavioral,population by supporting proven interventions to address behavioral,
social and, environmental determinants of health in addition tosocial and, environmental determinants of health in addition to
delivering higher-quality care.delivering higher-quality care.
9.9. Affordable Care:Affordable Care: Reduce the cost of quality health care forReduce the cost of quality health care for
individuals, families, employers, and government.individuals, families, employers, and government.
Healthcare Trends for 2015Healthcare Trends for 2015
Technology is Transforming the entire healthcare industryTechnology is Transforming the entire healthcare industry
Wearable Tracking DevicesWearable Tracking Devices
Patient Centered CarePatient Centered Care
Increased Data DemandsIncreased Data Demands
Attaining Meaningful UseAttaining Meaningful Use
Switching to ICD-10Switching to ICD-10
Data SecurityData Security

9. Current Health Problems in India:Current Health Problems in India:
Morbidity & Morality StatisticsMorbidity & Morality Statistics
Demographic conditions of the populationDemographic conditions of the population
Environmental factors influencing healthEnvironmental factors influencing health
Social-economic factors influencing healthSocial-economic factors influencing health
Cultural & its componentsCultural & its components
Medical & Health services availableMedical & Health services available
Other services availableOther services available
The importance of healthcare in india:The importance of healthcare in india:
Achievements in health worldwide in the twentieth century andAchievements in health worldwide in the twentieth century and
especially during the past few decades are impressive. The increase inespecially during the past few decades are impressive. The increase in
life expectancy and the decrease in fertility throughout the world havelife expectancy and the decrease in fertility throughout the world have
been greater in the past 40 years than during the previous 4000 years.been greater in the past 40 years than during the previous 4000 years.
Life expectancy is almost 25 years longer today than at similar incomeLife expectancy is almost 25 years longer today than at similar income
levels in 1900 (Preker A. et al 2000).levels in 1900 (Preker A. et al 2000).

10. Emerging trend in health careEmerging trend in health care
Health care has emerged as one of the largest service sectors in India,Health care has emerged as one of the largest service sectors in India,
rather dynamic, it is constantly developing building further on therather dynamic, it is constantly developing building further on the
areas it is most competentareas it is most competent
The health care deals with different services such as hospital services,The health care deals with different services such as hospital services,
diagnosis services, physician consultancies and some other emergingdiagnosis services, physician consultancies and some other emerging
fields. In the present study, the focusing services are all health carefields. In the present study, the focusing services are all health care
services together.services together.
At present mainly three policy initiativesAt present mainly three policy initiatives are in progress for healthare in progress for health
care for the poor. These include:care for the poor. These include:
1.1. Exemptions to the poor from users fee in government hospitals;Exemptions to the poor from users fee in government hospitals;
2.2. Provision of free of cost treatment to poor (subject to a proportion ofProvision of free of cost treatment to poor (subject to a proportion of
total patients) in private super-speciality hospitals; &total patients) in private super-speciality hospitals; &
3.3. Health insurance schemes for the poor.Health insurance schemes for the poor.
Twelfth five year plan for healthcare in India:Twelfth five year plan for healthcare in India:
The long term objective of this strategy is to establish a system ofThe long term objective of this strategy is to establish a system of
Universal Health Coverage (UHC) in the country. Following are the 12thUniversal Health Coverage (UHC) in the country. Following are the 12th
plan period strategy:plan period strategy:

11. Substantial expansion and strengthening of public sector health careSubstantial expansion and strengthening of public sector health care
system,system,
Health sector expenditure by central government and stateHealth sector expenditure by central government and state
government, will have to be substantially increased by the twelfth five-government, will have to be substantially increased by the twelfth five-
year plan.year plan.
Financial and managerial system will be redesigned to ensure efficientFinancial and managerial system will be redesigned to ensure efficient
utilization of available resources and achieve better health outcome.utilization of available resources and achieve better health outcome.
Increasing the cooperation between private and public sector healthIncreasing the cooperation between private and public sector health
care providers to achieve health goals.care providers to achieve health goals.
The present Rashtriya Swasthya Bhima Yojana (RSBY) which providesThe present Rashtriya Swasthya Bhima Yojana (RSBY) which provides
cash less in-patient treatment through an insurance based systemcash less in-patient treatment through an insurance based system
.Below Poverty Line(BPL) population will be covered through RSBY.Below Poverty Line(BPL) population will be covered through RSBY
schemescheme
In order to increase the availability of skilled human resources, a largeIn order to increase the availability of skilled human resources, a large
expansion of medical schools, nursing colleges, and so on,expansion of medical schools, nursing colleges, and so on,
A series of prescription drugs reforms, promotion of essential, genericA series of prescription drugs reforms, promotion of essential, generic
medicine and making these universally available free of cost to allmedicine and making these universally available free of cost to all
patients in publicpatients in public
Effective regulation in medical practice, public health, food and drugsEffective regulation in medical practice, public health, food and drugs
is essential to safeguard people against risks and unethical practices.is essential to safeguard people against risks and unethical practices.

13. QUALITY IMPROVEMENT & PERFORMANCEQUALITY IMPROVEMENT & PERFORMANCE
Quality improvement (QI) consists of systematic and continuousQuality improvement (QI) consists of systematic and continuous
actions that lead to measurable improvement in health care servicesactions that lead to measurable improvement in health care services
and the health status of targeted patient groups.and the health status of targeted patient groups.
Using knowledge gained from the disciplines of medicine, nursing,Using knowledge gained from the disciplines of medicine, nursing,
health-care management, and medical and health-services research, ithealth-care management, and medical and health-services research, it
attempts to mobilize people within the health-care system to workattempts to mobilize people within the health-care system to work
together in a systematic way to improve the care they provide.together in a systematic way to improve the care they provide.
QI program may appear different following four keyQI program may appear different following four key
principles: they are -principles: they are -
1.1. QI work as systems and processesQI work as systems and processes
2.2. Focus on patientsFocus on patients
3.3. Focus on being part of the teamFocus on being part of the team
4.4. Focus on use of the dataFocus on use of the data
The overall performance of the health care organization among theThe overall performance of the health care organization among the
patients in two different type of organizations are measured separatelypatients in two different type of organizations are measured separately
at five point scale namely highly satisfied, satisfied, moderate,at five point scale namely highly satisfied, satisfied, moderate,
dissatisfied and highly dissatisfied.dissatisfied and highly dissatisfied.

14. 10 Dimensions of healthcare quality10 Dimensions of healthcare quality
Availability & AppropriatenessAvailability & Appropriateness
Accessibility & AffordabilityAccessibility & Affordability
Equity & EqualityEquity & Equality
Technical Competence & skillsTechnical Competence & skills
Timeliness & continuityTimeliness & continuity
SafetySafety
Respect & Caring (I.P. relations)Respect & Caring (I.P. relations)
EfficiencyEfficiency
Effectiveness& EfficiencyEffectiveness& Efficiency
AmenitiesAmenities
3 Perspectives’ of Healthcare Quality3 Perspectives’ of Healthcare Quality
Healthcare Staff(Service providers)Healthcare Staff(Service providers)
Health Manager(administration)Health Manager(administration)
Clients (external & Internal)Clients (external & Internal)

15. PROBLEMS IN QUALITY HEALTH CAREPROBLEMS IN QUALITY HEALTH CARE
Unusual practicesUnusual practices by medical professionals in pricing of their services.by medical professionals in pricing of their services.
Variation in services:Variation in services: There continues to be a pattern of wide variationThere continues to be a pattern of wide variation
in health care practice, including regional variations and small-areain health care practice, including regional variations and small-area
variations.variations.
Underuse of servicesUnderuse of services. Millions of people do not receive necessary care. Millions of people do not receive necessary care
and suffer needless complication: that add to costs and reduceand suffer needless complication: that add to costs and reduce
productivity.productivity.
Overuse of servicesOveruse of services: Each year, millions of peoples receive health care: Each year, millions of peoples receive health care
services that are unnecessary, increase costs, and may even endangerservices that are unnecessary, increase costs, and may even endanger
their health. Research has shown that this occurs across alltheir health. Research has shown that this occurs across all
populations.populations.
ShortageShortage of technical and interpersonal competenceof technical and interpersonal competence

16. Future recommandation for quality:Future recommandation for quality:
Priorities for future study on qualityPriorities for future study on quality and quality improvement—and quality improvement—
particularly the overuse, underuse, and misuse of health care servicesparticularly the overuse, underuse, and misuse of health care services
—include:—include:
Identify which financial and organizational factorsIdentify which financial and organizational factors promote quality andpromote quality and
how different payment methods, financial incentives, andhow different payment methods, financial incentives, and
organizational factorsorganizational factors
Design and implement new care processesDesign and implement new care processes that enable patients to actthat enable patients to act
as co-managers of their health care, particularly for chronic illnesses.as co-managers of their health care, particularly for chronic illnesses.
Identify telecommunications applicationsIdentify telecommunications applications that will enhance patients'that will enhance patients'
access to information and patient-provider communication.access to information and patient-provider communication.
Identify effective information technologyIdentify effective information technology tools and systems that alerttools and systems that alert
providers in real-time to the critical information they need to provideproviders in real-time to the critical information they need to provide
safer, high quality care.safer, high quality care.
Implement and evaluate strategiesImplement and evaluate strategies to improve quality of care for peopleto improve quality of care for people
with disabilities.with disabilities.
Identify and address factors that promoteIdentify and address factors that promote adoption of promisingadoption of promising
quality improvement strategiesquality improvement strategies (e.g., patient self-management) by all(e.g., patient self-management) by all
who would benefit.who would benefit.

17. WHAT IS HEALT INSURANCEWHAT IS HEALT INSURANCE??
• SYSTEM OF ASSURANCE TO MAKE CONTINGENCIES OF HEALTHSYSTEM OF ASSURANCE TO MAKE CONTINGENCIES OF HEALTH
CARE EXPENSES.CARE EXPENSES.
• TO PROVIDE PROTECTION AGAINST FINANCIAL LOSS BYTO PROVIDE PROTECTION AGAINST FINANCIAL LOSS BY
UNFORSEEN SICKNESS.UNFORSEEN SICKNESS.
• TO MEET COST OF GOOD MEDICAL CARE.TO MEET COST OF GOOD MEDICAL CARE.
• RELIEVES ANXIETY AND TENSION.RELIEVES ANXIETY AND TENSION.
HEALTH INSURANCEHEALTH INSURANCE
Health Insurance can be broadly defined as a financial mechanism thatHealth Insurance can be broadly defined as a financial mechanism that
exists to provide protection to individual and households fromexists to provide protection to individual and households from
expenses incurred as a result of unexpected illness or injury.expenses incurred as a result of unexpected illness or injury.
Health insurance, which remains highly underdeveloped and lessHealth insurance, which remains highly underdeveloped and less
significant segment of the product portfolios, is now emerging as asignificant segment of the product portfolios, is now emerging as a
tool to manage financial needs of people to seek health services.tool to manage financial needs of people to seek health services.
The reasons for rise in health care cost are:-The reasons for rise in health care cost are:-
Increase in medical treatment costsIncrease in medical treatment costs
Technological advancements in medical equipmentTechnological advancements in medical equipment
High labour costs.High labour costs.

18. HEALTH INSURANCE IN INDIA & EMERGING SCENARIO OFHEALTH INSURANCE IN INDIA & EMERGING SCENARIO OF
HEALTH CAREHEALTH CARE
1.Rural Versus Urban Divide:1.Rural Versus Urban Divide: India still spends only around 4.2% of itsIndia still spends only around 4.2% of its
national GDP towards healthcare goods and services (compared tonational GDP towards healthcare goods and services (compared to
18% by the US)18% by the US)
2.2. Need for Effective Payment Mechanisms:Need for Effective Payment Mechanisms: According to the WorldAccording to the World
Bank and National Commission’s report on Macroeconomics, only 5%Bank and National Commission’s report on Macroeconomics, only 5%
of Indians are covered by health insurance policies. Such a low figureof Indians are covered by health insurance policies. Such a low figure
has resulted in a nascent health insurance market which is onlyhas resulted in a nascent health insurance market which is only
available for the urban, middle and high income populations.available for the urban, middle and high income populations.
3.3. Demand for Basic Primary Healthcare and InfrastructureDemand for Basic Primary Healthcare and Infrastructure: children: children
under five are born underweight and roughly 7% (compared to 0.8% inunder five are born underweight and roughly 7% (compared to 0.8% in
the US) of them die before their fifth birthday. For primary healthcare,the US) of them die before their fifth birthday. For primary healthcare,
the Indian government spends only about 30% of the country’s totalthe Indian government spends only about 30% of the country’s total
healthcare budget.healthcare budget.
4.4. Growing Pharmaceutical SectorGrowing Pharmaceutical Sector: According to the Indian Brand: According to the Indian Brand
Equity Foundation (IBEF), India is the third-largest exporter ofEquity Foundation (IBEF), India is the third-largest exporter of
pharmaceutical products in terms of volumepharmaceutical products in terms of volume
5.5. Underdeveloped Medical Devices SectorUnderdeveloped Medical Devices Sector: Recently, the government: Recently, the government
has been positive on clearing regulatory hurdles related to the import-has been positive on clearing regulatory hurdles related to the import-
export of medical devices,export of medical devices,

19. MAJOR CHALLENGES FOR INDIA IN THE HEALTH SECTORMAJOR CHALLENGES FOR INDIA IN THE HEALTH SECTOR
Manpower-Number & NormsManpower-Number & Norms
Rural/Urban differentialRural/Urban differential
Geographical divide across statesGeographical divide across states
S-E groups-accessibility/reachS-E groups-accessibility/reach
Gaps between policy and ActionGaps between policy and Action
Newer Infections’Newer Infections’
Lack of trained doctors, physicians & nursesLack of trained doctors, physicians & nurses
Lack of medical infrastructureLack of medical infrastructure
Health Status and risksHealth Status and risks
Issues of malnutritionIssues of malnutrition
Unequal distribution of resources & issues of low cost but effectiveUnequal distribution of resources & issues of low cost but effective
medical caremedical care
Lack of contribution by the societyLack of contribution by the society
Even though there is 100% FDI allowed in the health sector, there isEven though there is 100% FDI allowed in the health sector, there is
still not enough inflowstill not enough inflow

20. CONCLUSION:CONCLUSION:
The Indian health sector can be viewed as a glass half empty or a glassThe Indian health sector can be viewed as a glass half empty or a glass
half full. The challenges the sector faces are substantial from the needhalf full. The challenges the sector faces are substantial from the need
to improve physical infrastructure to the necessity of providing healthto improve physical infrastructure to the necessity of providing health
insurance & earning the available of trained medical personnel.insurance & earning the available of trained medical personnel.
Health care is only one determinant of health outcomes; good health isHealth care is only one determinant of health outcomes; good health is
also a result of better nutrition, safe drinking water and sanitation,also a result of better nutrition, safe drinking water and sanitation,
universal access to education, gainful employment, better working anduniversal access to education, gainful employment, better working and
living conditions, control over addictions as well as environmentalliving conditions, control over addictions as well as environmental
pollution (both material and cultural), the elimination of various formspollution (both material and cultural), the elimination of various forms
of discrimination, and equitable and inclusive development. Fair,of discrimination, and equitable and inclusive development. Fair,
accessible, affordable and public universal health care will not happenaccessible, affordable and public universal health care will not happen
overnight in India.overnight in India.
We concede that universalizing the health insurance is not the soleWe concede that universalizing the health insurance is not the sole
answer to India's health system problems. it offers opportunity toanswer to India's health system problems. it offers opportunity to
improve quality of private and the public sector through accreditationimprove quality of private and the public sector through accreditation
system. Finally, the scheme has a potential to strengthen the publicsystem. Finally, the scheme has a potential to strengthen the public
healthcare system by a carefully designed incentive system for publichealthcare system by a carefully designed incentive system for public
sector providers and improving infrastructure.sector providers and improving infrastructure.

21. CONCLUSION:CONCLUSION:
 Growth potential for the insurance sector is immense.Growth potential for the insurance sector is immense.
 Consideration required to poor & unemployed.Consideration required to poor & unemployed.
 Private health insurance has positive role to play.Private health insurance has positive role to play.
 Insurance sector needs to widen its scope from only providingInsurance sector needs to widen its scope from only providing
treatments facilities to promote & preventive health care.treatments facilities to promote & preventive health care.
 India lags behind in the key healthcare indicatorsIndia lags behind in the key healthcare indicators
 Inadequate & poor healthcare planningInadequate & poor healthcare planning
 Inequitable distribution of resources b/w states as well as urban RuralInequitable distribution of resources b/w states as well as urban Rural
settingssettings
 Low insurance penetrationLow insurance penetration
 Increase concentration on health & educationIncrease concentration on health & education
 Encourage participation of society towards health sector.Encourage participation of society towards health sector.

22. THANK YOUTHANK YOU