IMPROVING CONSUMER INTERFACE OF PRIVATE

Transcript:IMPROVING CONSUMER INTERFACE OF PRIVATE:
IMPROVING CONSUMER INTERFACE OF PRIVATE HEALTHCARE: REGULATING THE PRIVATE HEALTH SECTOR Center for Enquiry into Health and Allied Themes (CEHAT) Growth of the Private Health Sector in India In 1947, the private health sector provided only 5-10 per cent of total patient care (Sengupta 2005) but in 2004 it is 78 per cent in the rural areas and 81 per cent in the urban areas (MoHFW 2007). India’s public spending on health, after increasing between 1950–51 and 1985–86, stagnated during 1995–2005.It was down to 0·95 per cent of the GDP in 2005. In 2004–05, government expenditure (including external support) accounted for 22 per cent of total health and private spending in 2004–05 accounted for 78 per cent of the total spending on health (Shivakumar 2011). Public health expenditures across countries SHARE OF HEALTH EXPENDITURE Source: (MoFHW 2007 NSSO) Trends in Hospitalisation Public-Private Share of Care Characteristics Of The Private Health Sector Problem with Data Availability Qualified/Registered and Unqualified Practitioners Multiple Systems and Cross-practice Rural – Urban Divide Poor Registration and Standards of Private Hospitals Focus on curative care Unregulated Practice No price regulation Demand increases with increased supply Price escalates with increased supply System of kickbacks/cut practice Professional bodies unconcerned Why Regulate? Regulation aims at improving clinical performance (safety and quality) Regulation targets risk mitigation Regulation promotes ethics and social justice Regulation to protect professional standards What is Regulation? Source: Braithwaite, J., Healy, J., Dwan, K.,(2005) The Governance of Health Safety and Quality, Commonwealth of Australia Voluntarism- is based on an individual or organisational undertaking to do the right thing without coercion. Self-regulation- is where an organised group regulates the behaviour of its members (e.g. by establishing an industry-level code of practice). Economic instruments- involve supply-side funding sanctions or incentives for health care providers, and also demand-side measures that give more power to consumers. Meta-regulation- involves an external regulatory body ensuring that health care providers implement safety and quality programs and practices. Command and control- involves enforcement by government (e.g. ensuring compliance with rules for licensing facilities). Who should Regulate? Profession Independent agency Government Legislation Ethical codes Insurance Market What to Regulate? Clinical practice Quality and standards Protocols Economics Ethics Legal dimensions Regulating the Health Sector MACRO ASPECTS Fiscal Measures Legal Measures Professional Measures MICRO ASPECTS Audit of Medical Practice Setting of Minimum Standards Social Audit Micro Aspects Global Experience From professional ethics to legislation The insurance route Examples UK