Proposed National e health authority (NeHA) Blueprint by Dr. Rahul Sinha

Transcription

1 Proposed National e health authority (NeHA) Blueprint by Dr. Rahul Sinha In my view the proposed NeHA should be having the following objective:- To provide effective health care at affordable price to every citizen of the country irrespective of race, religion, caste or economic status through efficient use of electronic means. Electronic means should only act as a interface or bridge, bringing government`s policy, government`s agencies and public together. According to me following would be important components in fulfilling the above objective:- 1) Doctors 2) Insurance Companies 3) Cheap Drugs 4) Cheap Surgical Instruments 5) Cheap Pathologies and other testing laboratories 6) Good Affordable Hospitals 7) Mobile and Establishment of Various Servers 8) Yoga 9) Generation of Funds 10) Time frame for implementation of project I would present a blueprint for the proposed NeHA incorporating the above components, their role, problems associated, how to solve them and amendments needed in certain laws before launching NeHA. Besides there are certain issues which need quick attention. 1) Doctors :- Problem:- Most of the doctors practicing in government hospitals indulge in private practice and no government has been able to stop it. No Super Specialist doctor is going to practice in rural area. There is shortage of doctors in the country

2 Solution :- Three categories of doctors viz. (a) Super Specialist doctors:- Government should appoint a super specialist doctor per block or per two/three blocks in urban(they would never go to rural areas) areas in every district. Super specialist doctors would be reluctant for above scheme. Appoint them on contract if they are reluctant, if ready to serve as a government doctor, do not give them Non practicing allowance (NPA) and allow them private practice. Minimum 13 hours per week of work as per their convenience with certain minimum number of cases for surgery and OPD. Make it mandatory for every super specialist doctor to serve above scheme, minimum one year per three years. Most of the super specialist doctors would vehemently oppose the scheme. Give them option (i) Either to join the scheme or (ii) Repay the amount spent by government on them from graduation to super specialization within a period of next five years in a phase wise manner. (b) Specialist doctors:- For every block in rural and urban area appoint a specialist doctor similar to above provision with recoverable amount from graduation to specialization for reluctant doctors. Norms for urban areas- Minimum six hours per week. Norms for rural areas- Minimum four hours per week. (c) Graduate doctors:- The vacancies of doctors in government hospitals should immediately be filled, be it in Primary Health Centre`s(PHC), District Hospitals, Medical Colleges or AIIMS type hospitals. To meet shortage of doctors in PHC, appoint homeopathic and ayurvedic doctors after training them for six months in allopathic system of medicine with the rights given to them for prescribing Schedule H1 drugs.

3 Needless to emphasize ----Biometric attendance should be introduced in every hospital. Every Super specialist and specialist doctor should be given a unique ID and password for online consultation and digital signature certificates should compulsorily be issued to them to enable their prescription be directly loaded in online pharmacy. 2) Insurance Companies:- Health Insurance(HI) should be made compulsory for every family of the country which should be linked to Aadhar card. Every family should be provided a unique policy number(upn) and UPN should contain Aadhar number of all the family members and the aadhar number in turn should contain details of a person`s medical history. Problem of HI:- HI is too costly and unaffordable for many and if it is taken, the sum assured is too low to take care of the health needs. Solution:- Insurance is done on the basis of law of large numbers and if it is made compulsory, large proportion of people opting for HI would bring down the premium to a substantial level giving average profitability to the insurers. Normally all the policies of government are designed in the name of poor but they are not benefitted 100%. I would recommend that all the family of the country be divided into following six classes depending on the average annual income and accordingly HI premium subsidy and upper SA limit be decided :- (a) Average annual income of the family < Full subsidy on HI premium Sum Assured(SA) limited to Rs. 1 lakh per family. (b) Average annual income of the family between % premium of HI paid by insured family--sum Assured(SA) limited to Rs. 2 lakh per family.

4 (c) Average annual income of the family between % premium of HI paid by insured family--sum Assured(SA) limited to Rs. 3 lakh per family. (d) Average annual income of the family between % premium of HI paid by insured family--sum Assured(SA) limited to Rs. 4 lakh per family. (e) Average annual income of the family between % premium of HI paid by insured family--sum Assured(SA) limited to Rs. 5 lakh per family. (f) Average annual income of the family between > % premium of HI paid by insured family No upper limit Sum Assured(SA). If a particular family wish to opt for more SA, then subsidy would not be provided on increased SA, though they will be encouraged to do so by providing relief through income tax act. Family would mean husband, wife, two children below the age of 21 years, father, mother, father-in-law and mother-in-law. Further, no person can claim benefit simultaneously in two policies as the aadhar number can only be entered once and if a person wishes to shift to other UPN for e.g. an old age parent shifting from one son`s family to another son`s or daughter`s family, it should be allowed but only from next year. The year for UPN should start from 1 st Jan and end on 31 st of December. Health Insurance Vs Mediclaim type policies:- HI should replace mediclaim policies owing to the fact that mediclaim type policies are subject to annual renewal at the mercy of the insurance companies if a claim has arisen. The idea in NeHA is to provide hassle free treatment and not undue harassement. Coverage :- Minimum will be Hospital Cash Benefit(HCB) and Major Surgical benefit(msb). Insurance companies would be free to offer variation in policies over and above the minimum standards of protection.

5 Intellectual Property(IP) in Insurance business:- IP is no longer an unfamiliar term but for the Indian insurance industry. IP promotes innovation in an industry. The Indian insurance industry does not seek patent or copyright for their products or aspects of policies. This has led to imitation or copying of products from one insurance company to other not placing value on ingenuity or invention. The ultimate sufferer are the citizens of our country who do not have much choice in selecting variation in policies. IP promotes competition, leading to development of new type of products, lower premium and increased customer satisfaction. Indian Health insurance industry need to secure their products so that rival companies are not able to imitate their products and in the end customers are benefitted. Though business methods are non- patentable in India but the Patents (Amendment) Act 2005 does not define a mathematical / business method, a computer program per se or an algorithm. Thus, there is wide scope for patenting an insurance product. An eye opener for insurance companies is patent no granted by Indian patent office. The patent was issued for a computerized system and a method for performing insurability analysis. On the government side, government should at least explicitly allow patenting of health insurance products for effective development of HI industry. 3) Cheap Drugs:- Though India is the largest manufacturer of generics but drug prices in India are not that low as they should be. Reason being large profits for the retailers and Dealers. In some cases as high as 80%. There should be upper limit on it and it should not be more than 15%. There are no explicit rules in place regarding online pharmacies. It is unclear whether online pharmacies are allowed or not in India. Online pharmacies would greatly reduce the price of drugs. Online pharmacies with proper rules in place be allowed in India. Online pharmacies should only be allowed for those patients who opt for digital signature certificate to prevent fraud. There can be various models in online pharmacies like (a) direct supply by online sites (b) their collaboration with local pharmacies.

6 An issue in online pharmacy would be patent protection. Details on online pharmacy cannot be discussed here. It needs separate chapter for discussion Patients should directly be allowed to purchase drug from companies after submitting their prescriptions to the companies. There should be proper auditing of pharmaceutical companies and they should not be allowed to sponsor tours, deliver gifts etc. to doctors. This nexus needs to be broken at any cost. To reduce cost, government supply of drugs should be directly from companies through e tenders. A question is Will India remain only the largest manufacturer of generics. India has such a huge pool of scientists and doctors. Time has come when we should start innovating new drugs for diseases which are prevalent in India. This should be done by PPP model by launching a National Drug Innovation Program (NDIP). It is well known fact that neither the government laboratories nor the private laboratories have been able to innovate a single block buster drug. What we are doing is only incremental innovations. For NDIP, there is no need to establish dedicated laboratories as it will require huge funds. For long term vision NDIP should have experts comprising Scientists, Doctors, Intellectual Property personals and lawyers. Across the country there should be at least 50 laboratory spaces for NDIP and in a phase wise manner within a period of six years some new drugs should be developed for diseases prevalent in India A separate national data base of persons affected with communicable diseases should be created. Drug resistance is the reason for introduction of schedule H1 drug but diseases like TB have yet not been eradicated. MDR TB has come for lack of proper monitoring. Day-2-day monitoring through Asha workers be done. A swipe machine be given to asha workers and a card having aadhar details to every patient affected with communicable disease. On visit by asha worker the card should be swiped which automatically will mark attendance in the aadhar system.

7 Non intake of drugs by persons of any religion should lead to reduction in HI subsidy. Some questions which need answer before launching NeHA are:- Advertisement of drugs in India is not allowed according to Drugs and magical remedies act. The purpose of preventing advertisements according to Hon`ble Supreme court is to prevent self medication. Then why newspapers and television openly disobey the rules. Why is patent linkage not allowed in India. If patent linkage were responsible for high drug prices then since patent linkage is not allowed in India then why drug prices in India is so high. A separate department should be instituted which should act as a link between patent department and office of the Drug Controller General of India(DCGI). It is totally unacceptable that patent linkage cannot be provided as it will burden further the office of the overburdened DCGI. Then why have we signed WTO, TRIPS agreement. 4) Cheap surgical instruments:- Through make in India campaign we should produce cheap instruments as this will drastically reduce the price of high cost surgeries. For e.g. the high cost of stents is unaffordable by masses. 5) Cheap pathologies and testing laboratories:- Every pathology of the country should be given a unique number and there should be uniform rates for a particular test. Different pathologies charge different rates and very often it is exorbitant. Moreover, the report of every pathology should be online and doctors should not be allowed to refuse report of one pathology only on the ground that they have not referred to that particular pathology. 6) Good affordable hospitals:- AIIMS type hospitals should be opened in every state and if need be two or three according to the population. The decision of opening AIIMS in a particular area should not be on political basis, rather an expert committee would search and submit recommendations for it. 7) Mobile and establishment of various servers:- There is no gainsaying the fact that use of mobile would be most important in e health facility.

8 A dedicated one, two or three digit number be established for emergency cases in health insurance. After dialing the number for e.g. 999, a person should be connected with the national server. The computerized national server will ask for your UPN followed by aadhar number, followed by PIN so as to prevent unauthorized access. The server will confirm whether you need emergency treatment. The national server will connect with state server and which in turn will connect with district server which will send an alert along with aadhar number to emergency duty medical officer about the patient. By the time patient arrives in the hospital the medical officer will have access to a patient`s medical history through the computer system established in the hospital. System has to be worked out when a patient needs emergency medical attention at an address different from aadhar address. The district server will also send an alert option along with UPN, and aadhar number to the respective insurance company from which HI is taken for efficient and timely processing of claim. This way there shall not be any need to file claim. The insurance company will itself process the claim. If patient needs referral to more modernized hospital, it will immediately be done by the concerned emergency duty medical certificate through his digital signature certificate. The medical officer will update the details of the patient, the type of disease suffered etc. before referring. The next hospital will in turn be equipped and ready to receive and treat the patient. This should not be for government hospitals only. All the private and government hospitals and nursing homes be linked. Detail blueprint is there but it cannot be described here fully. 8) Yoga:- Yoga should be made compulsory from school onwards to make India healthy.

9 9) Funds :- The whole system would require huge funds which can be generated by imposing health cess of 2%. Moreover, 40% of the amount spent by corporates, PSU`s in fulfilling their Corporate social responsibility be utilized for e health campaign. 10) Time frame for implementation of project :- The overall process should be completed within a period of five years in a phase wise manner. A National Health Insurance Authority (NHIA) should be established which should have branches all over the state capital and all the districts of the country. It should have access to UPN and aadhar number. All the HI claim repudiation by insurance companies be looked after by the authority. It should finalize claims after one month of claim repudiation by the insurance company. All the claims repudiated by insurance company should directly be routed to the concerned district NHIA without the patient being involved. The NHIA should be like consumer courts with the chairman at district level being a retired District Judge and two other members one from medical field and one from insurance field. Similarly for state and national level. The chairman of NHIA should report directly to the Prime Minister and he / she shall be in charge of the overall Health Insurance, e health etc. There are many more things for e health authority, how it can be worked out etc. etc. but everything cannot be discussed here in detail. It needs broad discussion. If my views on NeHA looks anything appreciable to the government then I will put forward my views. ----Dr. Rahul Sinha Mob sinhaarahul@yahoo.co.in