WELCOMEWELCOME

ByProf.S.Chakraborty

DirectorJaipuria Institute of Management

Lucknow, INDIA.

GOAL OF DEVELOPMENTGOAL OF DEVELOPMENT

Social justice

something that goes beyond

Economic Growth

Development happens throughDevelopment happens through

• Income security

• Securities against contingencies

• Environmental security

Shifts in Employment patternsShifts in Employment patterns

From

• Having people on rolls

• Job growth in the organized sector

To

• Buying service from people.

• Job growth in the unorganized sector

• Lack of clear cut employer – employee relationship

• Increasing income insecurity

• Vulnerability of the workers

FalloutsFallouts

Social Security, social integration Social Security, social integration and healthand health

• Mortality, morbidity and life expectancy – all directly influenced by standards of living.

• Strong association between income inequality and excess mortality.

• Two – way casual relationship between health and wealth.

Need of the hourNeed of the hour

• Social protection

• Eradication of problems not just prevention of a decline

• Sophisticated forms of targeting and monitoring

• Innovations in the social sector.

Health care delivery scene in IndiaHealth care delivery scene in India

• Faced with the dual challenge of ‘diseases of poverty’ and ‘diseases of prosperity’

• Real vs articulated demand

• Public spending ratio is 1:3 between the poorest 20% and the richest 20%

Estimates of household expenditures/treatment costs Estimates of household expenditures/treatment costs per episode/per year in Indiaper episode/per year in India

Disease/Condition Estimated cost of treatment of one episode/per year

(in Rs.)

In terms of days of wages

lost to BPL* families

Heart disease

Diabetes with insulin

Cancer

Acute case of COPD**

Moderate asthma

Mood or bipolar disorders

Major cases of injury

11,000

5,000

15,000

32,000

16,200 – 20,600

3,000 – 6,000

9,000

333

100

454

969

624

182

273

* BPL: Below poverty limit; **COPD: Chronic obstructive pulmonary disease

• Creating efficiently targeted policies with widespread public participation

• Integration of social and economic policies

• Keeping the cost of administration low

• ‘Prevention’ against increases in deprivation

Key challengesKey challenges

• ‘Promotion’ of better chances of individual development

• Intensifying focus towards ‘needy’ (contribution or no contribution)

• Shifting away from large scale universal systems

in order to• enhance and protect peoples’ capabilities• provide benefits through public or collective

arrangements• help people to cope with various insecurity

dimensions- poverty levels- casualization of employment- gender inequality

• improve opportunities and choices before individuals.

Need of a focus shift in social securityNeed of a focus shift in social security

Poverty is not just a state of deprivation.

It is equally a state of vulnerability

PovertyPoverty

Does the assumption of ‘perfect market’ work?

Perhaps can work only when – those with greatest need are also those with most

resources

Market – oriented interventions in the Market – oriented interventions in the health sectorhealth sector

• Perfect information

• Free entry and exit

• Fair distribution of income with all having an ability to pay

Key assumptions in market Key assumptions in market functioningfunctioning

Wide range of market failures because of

- high element of risk and uncertainty - moral hazard- adverse selection- externalities- assymetrical distribution of income

Scenario in Health SectorScenario in Health Sector

Does the market – oriented health – care systems

actually work?

The big questionThe big question

Displayed characteristics

• Have an urban orientation

• Caters to those in the organized sector

Health care through social Health care through social security schemessecurity schemes

Employees covered under different Employees covered under different system (number in millions)system (number in millions)

Contributory Non-contributory

Total

Mandatory 9.1 13.18 22.28

Voluntary 18.6 10.22 28.82

Total 27.7 23.40 51.1

Low – income organized sector Low – income organized sector workersworkers

• For these workers there is a mandatory, contributory scheme known as Employee State Insurance Scheme (ESIS) run by Employee State Insurance Corporation (ESIC)

• As on March 31, 2006, ESIC covered around 8.5 million insured persons/family units

Notable features of ESISNotable features of ESIS

• Workers with a salary of less than Rs.10000 per month can join

• Workers earning less than Rs.50 a day (approximately $ 1) are exempt from contributing

Typology of Risk Pooling Schemes in Typology of Risk Pooling Schemes in India TodayIndia Today

Mandatory

Contribution

Voluntary Employees on Mar, 02 (in million)

Non – Cont.

Contribut.

Non – Cont.

Public sector Employees

Government*

Other Departments**

Quasi-Govt.***

CGHS EHS

EHS

EHS

10.76

3.62

6.02

Pvt. Sector Employees

Low-income #

Others

ESIS EHS

INS. EHS,INS

8.50

Quality of ServiceQuality of Service

Some common complaints are

long queues non – availability of good quality medicines problems with reimbursement non – availability of service in certain

geographical regions

Health securityHealth security

• Requires to ensure low exposure to risk

• Provides access to healthcare services along with ability to pay

Burden of treatmentBurden of treatment

Equals

Cost of treatment + loss of income

However

Little attention has been paid to the burden factor

Does health insurance answers the Does health insurance answers the need?need?

• Perhaps yes, for those who can afford to pay when they are healthy

• Apparently no, when it comes to the poorer section

Social security needs in Social security needs in developing countriesdeveloping countries

• To ensure that members of the society meet their basic needs as well as remain protected from contingencies.

• To enable members maintain a standard of living consistent with social norms.

What does it call for?What does it call for?

Greater emphasis on social justice and social rehabilitation

not limited to

only medical rehabilitation.

Envisaged needsEnvisaged needs

• Innovations in social sectors to make life better for our millions

• Focus on indigenous development with local expertise on local problems with local content of local relevance

• To create economic and social developments from below

Recent DevelopmentsRecent Developments• Universal health insurance scheme of Govt. of India

(focussed on BPL section)• Yeshasvani Co-operative health care scheme in Karnataka

(mainly focussed on farmers)• Innovations in Arvind eye care centre, Madurai, Tamil

Nadu (brought down the cost of cataract operations)• Kudumbashree programme in Kerala (state poverty

eradication mission)• Grassroots innovation augmentation programme (GIAN)• ………… and many more

Efforts of late …….

are in the right direction

India is on the move showing India is on the move showing signs thatsigns that

People have learnt to escape from old ideas

Serious note has been taken of what Amartya Sen had said, “Development without participation is a sin.”

As a consequenceAs a consequence

‘I’ in India has started changing

It is no longerIt is no longer• Immitation and inhibition

Instead it is

• Innovation and Creation of value from ideas

Thank YouThank You