HEALTH CARE REFORM

INTRODUCTION-
 Health care reform in India are taking place under the broad umbrella of Structural
Adjustment Programs (SAP) which is termed as the New Economic Policy (NEP).
These are two aspects of SAP: Privatization and liberalization.
 One of the goals of the health care reforms is Patients should have timely access to
high- quality medical care from the appropriate provider. Health care reform means
better care for everyone.
 Health care reforms improve the quality and safety of health care.
Health care reforms typically attempts to:
 Broaden the population that receives health care coverage through either public sector
insurance programs or private sector insurance companies.
 Improve the access to health care specialists,
 Improve the quality of health care,
 Give more care to citizens,
Decrease the cost of health care.

DEFINITION-
1. Health care Reform is defined as a sustained, purposeful change to improve the efficiency,
equity and effectiveness of the health sector’
(Berman 1995)
2. Health sector reforms is a group of projects that include communicable disease,
reproductive and child health programme and health systems to promote economic efficiency,
quality and reforms of public sector.
Senior World Bank Official, Delhi,2002.

GOAL-
 The goal of health care reforms is to make health care more accessible and available
to all citizens.
 Currently millions remain uninsured due to job loss, or because healthcare premiums
would simply be too costly.
 Ideally, healthcare reform would enable more, to become insured and also decrease
the cost of healthcare.
However this is a goal that is not so easily obtained due to the
complexities of the healthcare system and the quality of care provided here.
Primary objectives:
 Provide healthcare coverage for all.
 Decrease the costs of health care services and coverage.

IMPORTANCE-
 Reform will improve the delivery and quality of health care services.
 It will find new ways to improve the service delivery.
 It will improve the quality without necessarily raising the costs.
 It will pay more attention to those with chronic illness.

PRINCIPLES OF HEALTH SECTOR REFORMS-

 All people living in the India, regardless of health condition, should have
comprehensive, understandable and affordable health care coverage.
 All people living in the India should receive quality, affordable patient centered health
care.
 All people living in the India should have guaranteed access to preventive
servicesHealth care workforce should continue to grow.
 Supports of biomedical and health services research should be a national priority.
 Race, gender and geographic disparities in health and health care must be eliminated.
 Public health infrastructure should be strengthened .

HEALTH CARE REFORMS IN INDIA-

The Ministry of Health and Family Welfare is the Indian government ministry charged with
health policy in India. It is also responsible for all government programs relating to family
planning in India.
 
The Minister of Health and Family Welfare hold cabinet rank as a member of the Council of
Ministers.
 
The ministry is composed of three departments:
1. Department of Health
2. Department of Family Welfare
3. Department of AYUSH.

1. Department of Health-
The Department of Health deals with health care, including awareness campaigns,
immunization campaign, preventive medicine and public health.
Bodies under the administrative control of this departments are:
 
 National AIDS Control Program
 National Cancer Control Program
 National Filaria Control Program
 National Iodine Deficiency Disorders
 National Leprosy Eradication Program
 National Mental Health Program
 National Program for Control of Blindness
 Universal Immunization Program

2. Department of Family Welfare-

The Department of Family Welfare is responsible for aspects relating to family welfare,
especially in reproductive health, maternal health, pediatrics, information, education and
communications.
The Department of Family Welfare is responsible for:
 18 Population Research Centers at six universities and six other institutions across 17
states.
 National Institute of Health and Family Welfare, South Delhi.
 International Institute for Population Sciences. Mumbai.
 Central Drug Research Institute, Lucknow.

3. Department of AYUSH-
The Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy
deals with Ayurveda and other yoga, naturopathy, unani, siddha and homoeopathy and
other alternative medicine systems. The department was established in March 1995 as the
Department of Indian Systems of Medicine and Homoeopathy. The department is charged
 with upholding educational standards in Indian Systems of Medicine and Homeopathy
colleges, strengthening research, promoting the cultivation of medicinal plants used and
working on Pharmacopoeia standards.

A.N.A PROPOSAL FOR HEALTH CARE REFORM-

 Health care delivery system restructuring
 Universally available standard health care package
 Initial emphasis on pregnancy and children
 Changes to reflect changing national demographics.
 Long term care insurance coverage
 Insurance reform
 System review and evaluation
 Case managed health care
Decreased health care costs.

10 -points to improve the healthcare system in India-

Accessibility
 Free health camp should be promoted by government and public hospitals.
 Reasonable cost of the medical services for the economically weak people.
2. Accessibility
 Access to technological devices, applications and medical information should be
promoted by the Government.
 Patient friendly mobile applications which enable instant contact with the doctor
should be encouraged.
 Healthcare centers should be situated in central place where there are good transport
services.
3. Availability
 Most importantly availability of multi- specialty doctors 24x7 should be ensured by
the government.
 Healthcare centers should possess well equipped medical facilities.
4. Acceptability
 The physicians should make the patient understand the importance of health based
technological advancement.
 Patient’s acceptability can be point out by good inter personal skills of the doctor.
Patient’s acceptability is an essential tool to promote good health.

5. Prioritization of patients based on the nature of health issues

 By following such system strictly we will be able to meet the health needs of all.
 Patients, whose is not critically ill, in the Outpatient Department (OPD) or get treated
in day care.
 Accidents and Emergencies should be given first priority followed by geriatrics and
pediatrics age groups. Prioritization of patients based on the nature of health issues.
6. Doctor-Patient ratio
 Reservation for medical seats should be removed; medical seats should be available at
reasonable cost.
 Efforts have to me made jointly by the government and private sector to improve the
doctor to patient ratio.
 India has just 1 doctor for every 1,681 persons.

7. Work Force/Human Resource

 Better wages, awards, promotion and a standardized yearly salary hike should be
promoted by all government and private hospitals, medical colleges.
 The human resource techniques to employ people should be improved to increase the
employees in the medical fields.

8. Public-Private Partnership
 The awareness about PPPs much be encouraged through medical education in various
institutions, conferences related to PPPs should be conducted yearly.
 PPPs are a form of long-term contract between a government and a private entity,
through which the government and private party jointly finance public services.

9. Health Insurance/Social healthcare

  Enormous efforts have been made to enhance the reach of healthcare in India.
Health Insurance/Social healthcare
 The out of pocket expenditure on healthcare is about 85.9% (World Bank).
 Health insurance in India can be improved:
 Equal importance has to be given to cover primary and secondary healthcare needs
under insurance schemes.
 To deliver the insurance schemes more effectively, it should be backed up by
technology so that the citizens have an easy access to the health schemes.
 All Insurance companies should cover pre existing diseases.
 The waiting period for approval of insurance should be minimum and should not
cause inconvenience to the patients.
10. Quality
 The quality of medical care in India is on a decline due to shortage of medical
professionals, poor infrastructure, poor information technology, poor quality medical
research and survey.
 The quality can be improved by:
 Focus on increasing the number of doctors and paramedics
 Improvisation of infrastructure in hospitals
 Improvisation of healthcare information technology
 Quality research and surveys.

ISSUSES IN HEALTH CARE REFORMS-

1. Unequal distribution of health care resources India
2. Access difficulties to health care
 Geographical distance
 Socio-economic distance-
 Gender distance
3. Effect on health outcome indicators due to economic inequality
4. Private healthcare and economic inequality.

Problems in having Health Reforms in India-

 The issue of underfunding of health services.
  The investment by the government in health care been inadequate to meet the
demands of the people.
 The allocation for the health sector is only 3.5% of its resources.
 Gross Domestic Product is short of the World Health Organization.
 The grants from central government to the state governments has been declined.

RESEARCH ARTICLE-
A recent World Bank report acknowledges the facts that doctors over-prescribe drugs
recommend unnecessary investigations and treatment and fail to provide appropriate
information for patients even in private healthcare sector. The same report also states the
relation between quality and price that exists in the private healthcare system. The services
offered at a very high price are excellent but are unaffordable for a common man. This re-
emphasizes the role socio-economic inequality plays in healthcare delivery.

SUMMARY-
Health care reform is a general rubric used for discussing major health policy creation or
changes—for the most part, governmental policy that affects health care delivery in a given
place. The major goal of health care reforms are getting better/ more health care protection
for as many people as possible at the lowest possible cost.

CONCLUSION-
 Overall, India needs to reform its health care system through policies, medical
infrastructure, education and realization of right nutrition to lifestyle management.
Acute diseases over time will be at reactive end of the reforms. As quickly as
possible, health must become a priority issue for the government of India.
BIBLIOGRAPHY-
IN BOOK
1. Jogindra Vati, Principles of Practice of Nursing management and administration for
B.Sc. and M.Sc. Nursing. Jaypee brothers Publication 2013, first edition, Page no. 13-20.
2. Deepak K, Sarath chandran, C Mithun kumar, B.P, A comprehensive text book on
nursing management, EMMESS publication, Page no. 141-142
3. Kamaljit Kaur, Textbook of nursing management and services, Jaypee brothers
Publication 2013, Page no. 122-124.
4. I Clement, Management of nursing services and education, Second edition,
ELSEVIER Publication 2015, Page no.206-208.
IN NET
 https://www.slideshare.net/Jyothi19587/health-care-reforms
 https://en.wikipedia.org/wiki/Health_care_reform
 https://jamanetwork.com/journals/jama/article-abstract/2682349