Indian Health System is underperforming relative to most global benchmarks and even compared to local neighbours. This underperformance is both on intermediate indicators such as the efficiency of resource use, quality of services, and access to them as well as outcome indicators such as health outcomes, responsiveness, financial protection, and equity. For improving the Indian health System multilevel actions are needed, which includes health financing.
Dvara Research through this new workstream tries to layout pathways to enhance health financing in India to achieve universal healthcare. The below infographic illustrates the journey envisioned by us towards universal healthcare.
In structuring their health systems, many countries have borrowed from the principles of managed competition, a theory developed in the 1980s. In this paper, we delve into the case of the national health insurance system in Israel and analyse how managed competition has been implemented to regulate the system. We trace the evolution of the health system, provide an outline of its current design, and describe the emerging challenges that the system faces.
In this paper, we document the experience of Germany’s SHI system with managed competition and the challenges faced by this sub-system in faithfully implementing the principles of managed competition as originally envisioned by Enthoven.
In this paper, we look at what made a transition to managed competition possible in the Netherlands, how managed competition has played out, and the challenges that the system currently faces.
In this paper, we propose an analytical framework that provides an overview of the various actors and processes involved in financing, purchasing, provision and provider payments.
In this piece, we revisit Enthoven’s principles and propose a broader definition of the concept of managed competition in order that it may encompass other countries’ experiences that do not conform to a strict application of Enthoven’s concept.
In this paper, based on a study of the theoretical and empirical literature, we conclude with a set of hypotheses that looks at how demand for health insurance can be fostered by targeting both the components of demand (intention and action), through well-designed awareness measures and nudges to overcome the various behavioural biases involved.
In this paper, we analyse the political determinants of improved health outcomes, making a case for political attention to healthcare, through increased investments, healthcare reforms and improved capacity to deliver curative and public health.
In this paper, we analyse the role of the political economy of health in driving health outcomes and the financial burden of health, and make the case for political attention to healthcare, through increased investments, healthcare reforms and improved capacity to deliver health, both public health and curative.
In this paper, we provide a starting point to understand this problem and its first principles. We outline the problem and point to specific areas of high OOP spending that need further investigation. We explain how the current market structure and credit constraints, combined with the psychology of healthcare decision making leads to sub-optimal investments in health care and poor outcomes. Given this, we outline some areas of improvement and potential hypotheses to examine further through deeper literature review, expert interviews and primary research.
In India and South Asia, there are many challenges inherent to the delivery of equitable and accessible healthcare. In order to bridge these gaps, patients and caregivers need to be met where they are, and for preventive care delivery to be innovative, engaging, and customisable. This webinar will showcase creative examples that reimagine how patients and caregivers can be empowered at various points in their healthcare journey, discussing learnings from Noora Health, Jeeon, and Health Basix on how to ‘close the gap’ between care delivered in hospitals and homes, and how family caregivers, pharmacies, and schools can be a key link to ensure patients receive the best possible care.
The webinar is a joint Lancet Citizens’ Commission on Reimagining India’s Health System event with Dvara Research and HBS Health Care Initiative on the role of commercial health insurance in providing better health outcomes and improved financial protection in India. Comparing the experiences in different countries, the panel will discuss whether the integration of insurance and healthcare can solve the issues of information asymmetries in the market, what form would such an integration take, and what should be the regulator’s role. Further, it will explore the question of demand for insurance, what are the lessons for countries such as India from global experiences on commercial insurance, and how can the models be adapted to suit low-income consumers. As a Citizens’ Commission, we invite the public to participate in the discussion, provide input and engage with the panelists.
With large sections of the population continuing to spend significantly out of pocket, market based insurance mechanisms can offer an alternative. However, India’s indemnity based commercial health insurance with its complexity and a pre-dominant focus on hospitalisation is disconnected from consumer needs and does not account for lack of health insurance awareness and consumer’s behavioural biases in seeking healthcare and purchasing insurance. Community Based Health Insurance (CBHI) with its localised presence and emphasis on community participation in the design and delivery of health insurance is rightly placed to address some of these issues. However, the strengths of CBHI as a health financing instrument have not been completely explored and its reach remains limited. In this webinar, we will bring together perspectives of the regulator and experience from the ground to discuss the potential that CBHI offers to expand health coverage in India and its place in the larger healthcare system.
Recommended reading: Expanding Health Coverage through Community Based Health Insurance – Sowmini Prasad
This webinar is a joint event with King’s India Institute, King’s College London and Centre for Social and Economic Progress in the form of a panel discussion on the political determinants of health prioritisation. The panel explored cross national variations in levels of public health investment and political prioritisation of health system improvements. It also explored how and when cross-class coalitions have developed to push for stronger public health infrastructure, including in countries with large middle class reliance on private health. With insights from those who have been involved in the reforms or have studied the motivations for reforms, this panel discussion brought together global comparative insights into when, why and with what consequences political leaders have invested more in health. It concluded by reflecting on possible lessons for India.
Over the course of four sessions, distinguished panellists will take up some of the most pressing questions about the financing of healthcare, and suggest pathways and proposals for reforming healthcare in India that are rooted in our context and institutional abilities.
Recommended reading: Status of Health Systems in India at National and Subnational Levels – Hasna Ashraf & Nachiket Mor
Recommended reading: Commercial Health Insurance in India – Status and Challenges – by Sowmini Prasad & Indradeep Ghosh
Even though ESI is a great scheme on paper, there are significant problems with its implementation and therefore its effectiveness. In this webinar, our panellists will offer their thoughts on the current state of ESI and what needs to change in order for the scheme to truly deliver on its promise. A key focus of the webinar will be to bring forward and explore the beneficiary’s perspective on ESI – a perspective that is often missing in the public discourse on ESI.
Recommended reading: Employee State Insurance Scheme – Performance and Potential Pathways for Reform – by Sowmini Prasad & Indradeep Ghosh
Recommended reading: Pradhan Mantri Jan Arogya Yojana (PM-JAY): The Scheme and its Potential to Reform India’s Healthcare System – by Sowmini Prasad