Voucher Scheme PPT

8/17/2019 Voucher Scheme PPT

1/20

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2/20

•

2, 87, 000 maternal deaths across globe

• Third of these deaths: India witnessed 56,000 maternal deaths

(19 percent of the global burden)

• Ante- and postpartum hemorrhage (38 percent)

• Sepsis (11 percent)

• Abortion (8 percent)


3/20

(PHCs) lack

• Labour rooms (34 percent) and regular water supply (13

percent).

• Jharkhand where the shortfall in PHCs is the highest at 66

percent.

• 59 percent of PHCs having no electricity connection.


4/20

(CHCs) Lack

• Shortage of 69.7 percent in specialists

•

Shortfall of 74.9 percent of surgeons

• 65.1percent of obstetricians

•

79.8 percent of pediatricians


5/20

• The large scale - private health sector – highlight – issues,

including shortages of public healthcare .

• The existence of a large private sector in developing countries

presents an ‘Opportunity’ to increase access to key healthservices alongside longer term efforts to build up public sector

capacity.


6/20

Challenges for Private Health Sector

• Key Challenges for Private Health Sector to cater to low

income groups:

•

Private providers – unregulated - developing countries -quality of service - very low.

• Range of services - maximize revenue, instead of those

which offer the best public health outcome.

•

High Price


7/20

The objective of voucher schemes is to utilize the large but

unregulated private sector, by incentivizing providers to deliver

key health services at greatly improved standards, and to make

them affordable.


8/20

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• Voucher: A small printed piece of paper that entitles the holder

to a discount, or that may be exchanged for goods or services.

•

Scheme: A large-scale systematic plan or arrangement forattaining some particular object or putting a particular idea into

effect.

•

Voucher Scheme: It is a printed piece of paper that entitles theholder to avail a large-scale systematic plan which attains a

particular objective.


9/20

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• Voucher schemes – ‘Advantage’ of being able to ‘Target

services’ at ‘Specific groups’ according to Geographic,

Demographic or Socio-economic criteria.

• Primary beneficiaries – ‘Need’ the services most or ‘Difficulty’

in accessing public health services.

•

Not just that the ‘Service’ becomes affordable but that the‘Price’ becomes fixed.

• Client is able to exercise choice over which provider they visit.


10/20

India has initiated multiple programs to harness the private sector’s potential

for delivering healthcare by establishing public – private partnerships and

implementing voucher schemes with the objective of increasing equity inaccess to quality healthcare.


11/20

Chiranjeevi Yojna (2005 – Present)

• Location and Scale: Pilot in five districts of Gujarat (Banaskantha ,

Dahod, Kutch, Panchmahals, and Sabarkantha). Scaled up to the

entire State in 2007.

•

Incentives: Free institutional delivery for BPL women with free foodand medicines post delivery.

• Rs 200 as transport subsidy

• Rs 50 to attendant

• Rs 1,79,500 to private providers for every 100 deliveries (including

caesarean sections and complicated deliveries) with advance of Rs20,000

• Rs 65,900 to private practioners delivering in public facilities for 100

deliveries


12/20

Sambhav Voucher Scheme (2006 – 2012)

•

Location and Scale: Uttar Pradesh (seven blocks in Agra, 368 urbanslums in Kanpur Nagar) Uttarakhand (two blocks in Haridwar)Jharkhand (two blocks in Gumla)

• Incentives: Cashless package to BPL families.

•

Recognized private providers reimbursed

• Rs 3,200 for normal delivery

• Rs 5,500 for caesarean section

• Rs 2,000 for any complications

• Rs 450 for 3 ANCs and tests

• Rs 100 for 2 PNC visits

• Rs 2000 for infant health

• Rs 1500 for sterilization Rs 300 for IUDs

• Remuneration to ASHAs for promoting services, travel expenses


13/20

MAMTA Scheme (2008 – Present)

• Location and Scale: National Capital Territory of Delhi

• Incentives: BPL/SC/ST pregnant women who are residents of Delhi

and above 19 years of age with not more than one living child

entitled to free services.• ASHA/ANM reimbursed Rs 100 per delivery facilitated.

• Private providers (MAMTA Friendly Hospitals) are reimbursed Rs 4,

00, 000 for package of 100 deliveries including:

• Rs 1000 for normal delivery

•

Rs 5000 for caesarean section

• Rs 100 for each ANC and PNC

• Rs 1000 for medicines, immunization for new born


14/20

Janani Sahyogi Yojna (2006 – Present)

• Location and Scale: Madhya Pradesh (initiated in all 48 districts)

• Incentives: Access to delivery and newborn care services to BPL

women in private facilities.

•

Motivation charges of Rs 200 to ASHAs, AWWs• Private providers received

• Rs 1200 for normal delivery

• Rs 5500 for caesarean section

• Rs 750 for blood transfusio

• Rs 50 for baby warmer

• Rs 50 for pediatrician visit


15/20

Challenges

Social Provider

Interest

Over servicing


16/20

Social And Traditional Customs

• What?

! Home births

! Traditional birth attendants or ‘dais’

• Why?

! Low social status

! Lack of decision making power within the household

!

Low levels of literacy and limitations of financial resources

• Solution:

! ASHAs and AWWs play a pivotal role in convincing families


17/20

Sustaining Provider Interest

• What?

! The reimbursement rates fixed

• Why?

! Rates do not cover the costs involved

• Solution:

! Consultation with multiple stakeholders (Board of Members)

! Packages should be designed in a manner that covers other

costs (consulting specialists and medicines prescribed)

! Framework - the funds transferred in a time-bound and

transparent manner.


18/20

Over servicing

• What?

! Provide more expensive services to someone who does not

need it.

•

Why?

! Boost its revenue flows and hence profits

• Solutions:

!

Framework

! Putting a limit to the service


19/20

Cream skimming

• What?

! Cater to low-cost cases and refer the more expensive

complicated cases to other facilities or public hospitals.

•

Why?

! reimbursement rates do not cover the cost of handling

complications adequately.

•

Solutions:

! Emergency Funds


20/20

Voucher Scheme PPT

Documents

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