Healthcare Karthik R Iim Indore

Ignite - Healthcare KARTHIK R

“If we stop thinking of the poor as victims and start recognizing them as value-conscious consumers, a whole new world of opportunity will open up.” -C.K. Prahlad

Premise “When patients go to many of the primary health centers, they find no one there. Sometimes, when they find someone, they will be referred to private doctors. Also, the medical system in the public sector offers no diagnostics, even of basic illnesses like malaria or TB. Patients are usually told to go to private practitioners for testing. Sometimes the testing isn't very good and, in any case, the economic cost could be ruinous.” Amartya Sen as told to The Hindu (Jan 2005)

The price of healthcare in Rural India is two to three times the price in the cities Poor accessibility increases transportation costs Lack of primary health care facilities leads to worsening of existing condition and increases cost of treatment Almost half the “doctors” in villages don’t even have a medical degree Rural people are willing to pay if we can provide quality products/services and this includes healthcare

Hitherto: What has been done Yeshasvini Health Insurance Scheme A self funding micro health insurance scheme started by Dr. Devi Shetty in Karnataka. Farmers pay a monthly premium of Rs 5 for coverage Very successful scheme providing health insurance to over 2.2 Million farmers in Karnataka through a network of hospitals and government subsidy

Mobile Medics Healthcare A venture by BITS Pilani Alumni which provided mobile clinics using vans in villages of Rajasthan Challenges during implementation because of inability to integrate backwards to include hospitals and higher end medical care and recruit doctors

A New System The proposed system involves a combination of hitherto mentioned schemes and applying it to the context of Indian Rural Health System A Primary Health Centre (PHC) will be setup, which is a small hospital equipped with 4-6 beds and manned by a Medical Officer who will be on the payroll of the organization. Such PHCs cater to around 8-10 villages. The purpose of each PHC is to ensure medical coverage for all the villages under it. For this purpose, every PHC is served by 2-3 ambulances called Mobile Medical Centers (MMCs) An MMC visits every village at least once a week and sets up a clinic for that day providing medical attention to those who are a part of the scheme. Each MMC has a qualified doctor. The doctors would either be volunteers from a network of NGOs working on weekends or paid professionals for the organization. In addition to visiting the villages once a week, the MMC can be used in emergencies by dialing a hotline number. The MMC will then ferry the patient to its PHC Every 8-10 PHCs are connected to a Specialty Health Centre (SHC), which are basically Private hospitals with capacity of over 30 beds and special facilities including Surgeons, anesthetics, X-rays etc. These SHCs are not owned by the organization unlike PHCs and MMCs. Instead these are a part of the network built to provide specialized medical care in case of emergencies.

Proposed Model

Proposed Model VILLAGES

PRIMARY HEALTH CENTRE

VILLAGES

MOBILE MEDICAL CENTRE

MOBILE MEDICAL CENTRE

SPECIALITY HEALTH CENTRE (PRIVATE HOSPITAL)

VILLAGES

PRIMARY HEALTH CENTRE

VILLAGES

Funding and Costs Villagers pay an insurance premium each month, which varies between Rs 20 - Rs 50 depending on the population of the village and the ability to pay. The insurance guarantees medical expense coverage for the entire family including consultation, drugs and surgery For families, a discount on the insurance premium can be given due to economies of scale The costs include Buying vans for MMCs Doctor’s salaries Building of PHCs Operational expenses and buying of equipment and drugs To limit the costs from insurance claims from becoming exceptionally high and to pay the Partner hospitals in case of very expensive treatments, a Reinsurance policy is adopted, where the organization is insured against unforeseen raise in claims.

Feasibility From the Yeshasvini scheme, it was observed that of the 2.2 Million farmers only a few thousand claimed the insurance. On an average, an operation costed Rs 10000 From the calculations shown we can conclude that every PHC can run profitably provided the scale is achieved. That depends to a large extent on the implementation and quality of healthcare provided. With a village of 500 people, the SHC which serves 100 villages can make profit of Rs 0.3 Crores. (Assuming 3% claims) The fixed costs of buying ambulances and building PHCs can be quickly recovered through this estimate

Conclusion A self funding healthcare scheme that addresses the three problems plaguing the system of healthcare in rural India Accessibility

Affordability Quality

If the misery of the poor be caused not by the laws of nature, but by our institutions, great is our sin. Charles Darwin