Financing Social Care ProgrammeDEBASISH ADHIKARI

M2016PHHP003

GUIDED BY: PROF. SHANKAR DAS

Sources of funding

Source: National Health Account Estimates for India 2013-14; NHRC; MoHFW; GOI

Expenditure Pattern

Source: National Health Account Estimates for India 2013-14; NHRC; MoHFW; GOI

Options for fundingEurope:

After World War II, Two major types of public health systems emerged, named after their political instigators:

Bismarck systems: based on social insurance, with a multitude of public insurance funds, financed by employer-employee contributions, independent of health care provision. Examples are Belgium, France and Germany.

Beveridge systems: where public financing and health care delivery are handled within one tax-financedstructure, such as the National Health Service (NHS) in the UK and in some Nordic states.1

South East Asia:

1) The poor and vulnerable are accepted to need highly subsidised arrangements by general budget, and thereis good evidence from Laos and Cambodia that demand-side targeted approaches such as health equity fundswork better than a simple fee exemptions policy.

2) The informal sector and the rest of the population remain a challenge, with countries such as the Philippinesand Vietnam seeking to expand coverage through contributory arrangements, and others such as Thailand usingtax funding.2

Source: 1. Liaropoulos L and Goranitis I; 2015; Health care financing and the sustainability of health systems; International Journal for Equity in Health (2015) 14:80 DOI 10.1186/s12939-015-0208-52. Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid S A, Mukti A G, Akkhavong K, Banzon E, Huong D B, Thabrany H, Mills A; 2011; Health-financing reforms in southeast Asia: challenges in achieving universal coverage; The Lancet; 377: 863–73 DOI:10.1016/S01406736(10)61890-9

Challenges and Opportunities• Momentum of Population Growth

• Double burden of diseases

Demographic and Social

• Inter-Sectoral Co-ordination

• Universal Health Coverage

Health and Social Care System Design

• Innovation and technologyQuality and Productivity

• Fair Financing

• Evidence based objective evaluationFinancial and Economic

Source: Healthcare systems and services. (2012). http://www.mckinsey.com/~/media/mckinsey%20offices/india/pdfs/india_healthcare_inspiring_possibilities_and_challenging_journey_executive_summary.ashx

Financial Assessment

Cost Identification

Cost Description

Cost Minimization

Analysis

Cost Comparison

Analysis

Source: Duenas, A. (2013). Cost-Minimization analysis. In Encyclopedia of Behavioral Medicine (pp. 516–516).doi:10.1007/978-1-4419-1005-9_1376

Social Care Program (1947-2016)Community Development Programme (1952)

Food For Work Programme (1977)

Integrated Rural Development Programme (1974)

Integrated Child Development Services (1975)

Indira Awaas Yojana (1985)

Midday Meal Scheme (1995)

Pradhan Mantri Gram Sadak Yojana (2000)

Swarnajayanti Gram Swarozgar Yojana (2001)

Mahatma Gandhi National Rural Employment Guarantee Act (2005)

Janani Suraksha Yojana (2005)

Rashtriya Swasthya Bima Yojana (2008)

Smart Cities Mission (2015)

Union Budget, 2016-17(Allocation for Social Care Programme)Name of Program Budget (Cr.)

Make In India 324

Digital India 1,282

National Action Plan for Climate Change 180

AYUSH Promotion 400

National Health Mission 19,000

Pradhan Mantri Swasthya Suraksha Yojana 2,450

Aam Admi Bima Yojana 450

Atal Pension Yojana 200

Student Financial Aid/ Scholarship 4,031

Deendayal Upadhyaya Gram Jyoti Yojana 3,000

Pradhan Mantri Kaushal Vikas Yojana 1,700

Scheme for Safety of Women 150

Source: Key features of budget 2015-2016. (2015). http://indiabudget.nic.in/ub2015-16/bh/bh1.pdf

Financial Integration across health and social careAny discussion of integration requires careful definition to ensure common understanding. A helpfulcharacterization is of a continuum extending from relative autonomy to structural integration.

Three levels of integration can also be identified: macro (strategic); meso (service level); and micro(individual user).

Type of Financial Integration:

1. Grants Transferred Between health and social care bodies

2. Cross Charging (Transaction Payment) 3. Aligned Budget

4. Lead Commissioning 5. Pooled Funds

5. Integrated Management without pooled funds 6. Integrated management with pooled funds

7. Structural Integration

Source: 1.The Institute for Research and Innovation in Social Services (IRISS). (2012). Integration of health and social care.https://www.iriss.org.uk/sites/default/files/iriss-insight-14.pdf2. Weatherly, H., Mason, A., Goddard, M., & Wright, K. (2010). Health and community care financial integration across health and social care: Evidence review. http://www.gov.scot/Resource/Doc/303234/0095107.pdf

Health and Social Care System: Spain

Healthcare: National Health Service, est. 1995 guarantees basic health care to all Spanish citizens. Financed mainly by central taxation, the NHS provides health promotion, inpatient, outpatient and pharmaceutical care, but excludes dental, social and community care.

Social Care: Access and entitlement to social care is discretionary. The transfer of social services to the Autonomous Communities (ACs) was completed by 1997, with interregional coordination. AC social services are responsible for social and community care for a variety of vulnerable populations including those with intellectual disabilities, physical disabilities, mental disorders, drug addiction as well as older people.

Key policies and legislation: 1986 General Health Care Act determined that health care areas, as well as the regional governments and the central state, should produce their own health plan, through a process of broad social participation. Integration of mental health services within general health care system.

Source: Weatherly, H., Mason, A., Goddard, M., & Wright, K. (2010).Health and community care financial integration across health and social care: Evidence review.http://www.gov.scot/Resource/Doc/303234/0095107.pdf

Health and Social Care System: CanadaHealthcare: Mix of public (tax) and private funding. Federal funds distributed between ten provinces and threeterritories. Publicly funded hospital and physician services. Funding and organisation of community andinstitutional continuing care do not provide same comprehensive coverage and vary between and within theprovinces.

Publicly and privately funded services (e.g. long-term care, pharmaceuticals).

Privately funded (e.g. cosmetic surgery).

Social Care: Three levels of governance for integrated service networks, (i) Ministry of Health and Social Servicesat the regional level (18 regional agencies) (ii) local level (iii) nine programmes of care. Long-term care andhome care is financed at a provincial level and there is wide variation in coverage between and within theprovinces in terms of eligibility conditions, covered services and cost-sharing arrangements.

Key policies and legislation: 2004 onwards generalised and specialised hospitals, LTC hospitals and local community service centres (CLSCs) in each local territory have been required to merge and to coordinate activities with other providers e.g. community organisations and inter-sectoral bodies such as municipalities

Source: Weatherly, H., Mason, A., Goddard, M., & Wright, K. (2010).Health and community care financial integration across health and social care: Evidence review.http://www.gov.scot/Resource/Doc/303234/0095107.pdf

Health and Social Care System: The Netherland

Healthcare: Major reform in 2006 introduced a mandatory private insurance system with regulated marketcompetition. All residents must purchase a basic health plan from a free choice of insurers. Insurers receiverisk-adjusted capitation payments funded by government (for under 18s and low-income) and employeecontributions. National health insurance based on managed competition in the private sector.

Social Care: Exceptional Medical Expenses Act covers long-term care and some preventative services fundedunder a social health insurance scheme.

Key policies and legislation: Health Insurance Act (2006). Mandatory purchase of private health insurance,with a legally prescribed benefit package, from a private insurance company. Contrary to the previous privateinsurance scheme, insurers are legally obliged to accept each applicant for a basic insurance contract at acommunity-rated premium and without exclusion of coverage because of pre-existing conditions.

Source: Weatherly, H., Mason, A., Goddard, M., & Wright, K. (2010).Health and community care financial integration across health and social care: Evidence review.http://www.gov.scot/Resource/Doc/303234/0095107.pdf

The debate on sustainability in financing:new challenges in the 21st century•Globalization and income inequality

•Recession and economic uncertainty

•Financing sustainable health care: who must pay and how?

Source: Liaropoulos L and Goranitis I; 2015; Health care financing and the sustainability of health systems;International Journal for Equity in Health (2015) 14:80 DOI 10.1186/s12939-015-0208-5

Role Model to achieve UHCSouth Korea introduced mandatory social health insurance for industrial workers in largecorporations in 1977, and extended it incrementally to the self-employed until it covered the entirepopulation in 1989. Therefore, from the introduction of social health insurance, it took only 12years for Korea to achieve universal coverage of its population.

National health insurance in Korea used to have multiple insurance societies covering employeesand the self-employed separately, although claim review and payment to health care providerswere centralized, and statutory benefit packages were identical across schemes. In 2000, there wasa major change in the structure of the health insurance programme, and all insurance societieswere merged into one single payer.

A mix of social insurance and tax can work well for health care financing systems in low- andmiddle-income countries.

Political commitment and family-based membership contribute to rapid population coveragemoving toward universal health care coverage.

Effective health care purchasing and the regulation of health care providers are key factors in thesustainability of health care financing.

Source: Kwon S; 2009: Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage; Health Policy and Planning 2009;24:63–71 doi:10.1093/heapol/czn037

Reference1. National Health Account Estimates for India 2013-14; NHRC; MoHFW; GOI

2. Liaropoulos L and Goranitis I; 2015; Health care financing and the sustainability of health systems; International Journal for Equity in Health (2015) 14:80 DOI 10.1186/s12939-015-0208-5

3. Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid S A, Mukti A G, Akkhavong K, Banzon E, Huong D B, Thabrany H, Mills A; 2011; Health-financing reforms in southeast Asia: challenges in achieving universal coverage; The Lancet; 377: 863–73 DOI:10.1016/S01406736(10)61890-9

4. Healthcare systems and services. (2012). http://www.mckinsey.com/~/media/mckinsey%20offices/india/pdfs/india_healthcare_inspiring_possibilities_and_challenging_journey_executive_summary.ashx

5. Duenas, A. (2013). Cost-Minimization analysis. In Encyclopedia of Behavioral Medicine (pp. 516–516).doi:10.1007/978-1-4419-1005-9_1376

6. Key features of budget 2015-2016. (2015). http://indiabudget.nic.in/ub2015-16/bh/bh1.pdf

7. The Institute for Research and Innovation in Social Services (IRISS). (2012). Integration of health and social care. https://www.iriss.org.uk/sites/default/files/iriss-insight-14.pdf

Reference8. Weatherly, H., Mason, A., Goddard, M., & Wright, K. (2010). Health and community care financial integration across health and social care: Evidence review. http://www.gov.scot/Resource/Doc/303234/0095107.pdf

9. Kwon S; 2009: Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage; Health Policy and Planning 2009;24:63–71 doi:10.1093/heapol/czn037