report âKey Indicators of Social Consumption in India: Healthâ based on its 71st ... population had access to any form of health insurance coverage (See figure 1).
Volume 5 Number 1 April-July 2016
News Across Asia
ISSN 2308-1945
MEMBER-REPORTED NEWS Current Situation of Health care Coverage in India Ambrish Singh, M.Tech (Biotechnology), Independent Health Policy Researcher, India The National Sample Survey Office (NSSO), established in 1950, is the largest organization in India responsible for conductin g regular socio-economic surveys. It reports to the Ministry of Statistics of the Government of India and performs duties such as planning and formulation of the surveys, preparation of survey reports, analysis and presentation of the survey reports, and other important responsibilities. In the month of April 2016, the NSSO released the report “Key Indicators of Social Consumption in India: Health” based on its 71 st round of surveys. The survey carried out between January and June 2014 was aimed to generate basic quantitative information on the health sector in India. It was found that more than 80% of Indians are not covered under any health insurance plan, and only 14 % (government funded 13%1) of the rural population and 18 % (government funded 12%) of the urban population had access to any form of health insurance coverage (See figure 1). Analyzing the data classified as per Usual Monthly Per Capita Expenditure (UMPCE), the insurance coverage was found to be associated with the standard of living level, especially in the urban clusters. In urban populations, 67% of the high-income group population and 91% of the lower income group population were not covered, while the figure for rural population was 81% and 89% respectively. Apart from considering affordability, one other reason for this disparity could be the higher awareness among the high-income urban population. The reason noted for treatment without medical advice was “financial constraint” as cited by over 57% of
Figure 1: Health Insurance Coverage in India:
rural and 68% of urban population responders, respectively. The accessibility to health care facilities was
Stats from NSSO survey
the second most important concern in rural India as 15% of the rural respondents cited “no medical facility available in the neighborhood” as a reason; whereas for the urban population, the figure was just 1%. The expenditure on medicine was found to be the major contributor toward the health care economic burden on the Indian population. At the pan-Indian level, 71% of the rural and 68% of the urban total medical expenditure was used for procuring medications. The remainder constituted doctors’ fees (14% and 16%) and others (15% and 16%), respectively. Considering reimbursement for hospitalization expenses, the expenditure was reimbursed partly or fully only in 1% of the cases in rural areas, whereas for the urban areas it was noted to be 6%. The state of Maharashtra realized the highest percentage of hospitalization being reim bursed at 12% while the Madhya Pradesh was at the bottom with only 6% of hospitalizations being reimbursed. These figures further strengthen the case for broader health care coverage to enable the population to take correct medical advice when required. At the same time, only providing the coverage is not enough. Currently, there are more than 40 different health care coverage schemes in India either being run by the central government or by various state governments, and the population still has very limited access to insurance coverage overall. Thus, there exists a need not only to develop the new health care coverage schemes but also properly govern existing ones and promote awareness so that the benefit would reach more citizens. 1. Government funded refers to the percentage of the population which was covered under government of India sponsored or any state government spon-
sored health insurance scheme. So it means that the remaining percentage of population was covered under private insurance which they would have bought by themselves
Enhancing Transparency on Patient Out-of-pocket Market Prices Sang Soo Lee, MBA, Corporate Affairs Director, Medtronic Korea, Seoul, South Korea On May 1st, the Korean Ministry of Health and Welfare (MoHW) announced public opinion gathering about the newly developed regulation, “Criteria for Public Release of Patient Out-of-pocket Medical Treatment Costs” which will take effect on September 30th, 2016. This regulation is to promote transparency of patient out-of-pocket market prices. There have been demands by the general public to put in place transparent market price information on the medical services paid by patients out-of-pocket. Unlike the reimbursement coverage services, there is no market price control mechanism for the services paid by this scheme and the price variation is significant from hospital to hospital. This regulation is expected to help patients make better informed decisions with the price information. There will be 32 treatment items (i.e. ultrasonography, robotic surgery, MRI scanning, dental implants, etc.) and 20 certificate issuance charges (i.e. medical certificate, death certificate, birth certificate, etc.) that are subject to fall under this regulation. The drug prices paid by patient out-of-pocket are not subject to this regulation. Health Insurance Review and Assessment Service (HIRA) is commissioned to execute the gathering of patient out-of-pocket market prices and make the information public. HIRA requires hospitals to submit relevant information on patient out-of-pocket payments and will release the gathered information by hospital, service item, maximum/minimum price, and other inputs through its website. The service items released are determined by considering factors on clinical importance, frequency or weight of patient out-of-pocket identified through data obtained by HIRA or other sources, service items attracting social interests including patient safety, and others. The 1st public information release will be made on December 1st, 2016 and subsequent releases will continue on April 1 of every year. For hospitals with less than 150 beds and recuperation hospitals, this regulation will be applied on January 1, 2017 and the information about those hospitals will be first released on April 1, 2017.
Copyright © 2016, International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
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