HEALTH

CARE
REFORMS

Health care reform is a general

rubric used for discussing major
health policy creation or
changesfor the most part,
governmental policy that affects
health care delivery in a given
place.

OBJECTIVES

Broaden the population that receives health

care coverage through either public sector
insurance programs or private sector insurance
companies
Expand the array of health care providers
Improve the access to health care specialists
Improve the quality of health care
Give more care to citizens
Decrease the cost of health care

MAJOR GOAL

Getting better/ more

health care protection for
as many people as
possible at the lowest
possible cost.

EVOLUTION OF
HEALTH CARE
CHANGES

1. MEDICINE IN
ANTIQUITY.
2. DAWN OF SCIENTIFIC
MEDICINE
3. MODERN MEDICINE

MEDICINE IN ANTIQUITY.

In ancient times, health and illness

were interpreted in a cosmological
and anthropological perspective.
Medicine was dominated by
magical and religious beliefs which
were an integral part of ancient
cultures and civilizations.

1. PRIMITIVE MEDICINE
Evidence from cave art, daring back at
least 30,000 years, suggests caves were
used for magical ritual purposes. Shamans
were considered as the head of conducting
rituals
Primitive medicine frequently performed a
type of brain surgery that we today call
trephination. Trephination was done by
using stone instruments to bore or grind
holes in the skull

2. TRIO INDIAN
MEDICINE

AYURVEDA:

The practicals fields of Ayurveda are

divided into eight sections or branches.
These sections are: internal medicinal,
surgery, cranial organo medicine,
pediatrics, toxicology, rejuvenating
remedy, aprodisiac remedy and
spiritual healing. These eight sections
are called "Astanga Ayurveda.

Kayachikitsa
(Internal
medicine)

Baala chikitsa
(Pediatrics)

Graha chikitsa
(Demonology)

Urdhvanga
Chikitsa
(Diseases of head
& neck)

Shalya chikitsa
(Surgery)

Visha chikitsa
(Toxicology)

Jara chikitsa
(Rejuvenation)

Vrsha chikitsa
(Aphrodisiac
therapy)

SIDDHA MEDICINE.

The Siddha medicine is a form of south

Indian Tamil traditional medicine and
part of the trio Indian medicines ayurveda, siddha and unani. This
system of medicine was popular in
ancient India. The system is believed to
be developed by the 18 siddhas in the
south called siddhar.

UNANI MEDICINE.
Unani-tibb or Unani Medicine its
origin to Greece. It was the Greek
philosopher - Physician Hippocrates
(460-377 BC) who freed Medicine
from the realm of susperstition and
magic, and gave it the status of
Science. The theoretical framework of
Unani Medicine is based on the
teachings of Hippocrates

Chinese medicine

Egyptian medicine.

Mesopotamian medicine

Greek medicine
The Greeks taught men to think in terms of
why and how. The medical historian, Douglas
Guthrie has reminded us of the legend that
Hygiea was worshipped as the goddess of health
and Panacea as the goddess of medicine.
Panacea and Hygiea gave rise to dynasties of
healers (curative medicine) and hygienists
(preventive medicine) with different
philosophies. Greatest physician in Greek
medicine was Hippocrates who is often called as
the father of medicine.

Roman medicine

II. DAWN OF
SCIENTIFIC
MEDICINE

Revival of medicine
Sanitary awakening
Rise of public health
Germ theory of disease
Birth of preventive
medicine

Florence nightinagle.

GERM THEORY

GERM THEORY OF
DISEASE-LOUIS PASTEUR

III. MODERN MEDICINE

Curative medicine
Preventive medicine
Social medicine

CHANGING CONCEPTS IN PUBLIC

HEALTH
.
Disease control phase(1880-1920)
Health promotional phase(1920-1960)
Social engineering phase.
Health for all phase

HEALTH CARE
REFORMS IN
INDIA

1. COMPREHENSIVE CARE

The Bhore committee (1946)defined comprehensive

health care as the following criteria.
I. Provide adequate preventive, curative and
promotive health services.
II. Be as close to the beneficiaries as possible.
III. Widest cooperation between the people, the service
and the profession.
IV. Is available to all irrespective of their ability to pay
V. Look after specifically the vulnerable and weaker
sections of the community.
VI. Create and maintain healthy environment both in
home as well as working places.

2. BASIC HEALTH SERVICES.

A basic health service is understood to

be a network of coordinated, peripheral
and intermediate health units capable of
performing effectively a selected group
of functions essential to the health of an
area and assuring the availability of
competent personnel and auxiliary
personnel to perform these functions.

3. PRIMARY HEALTH CARE

Before Alma Ata primary health care was regarded as

synonymous with basic health services, first contact
care, easily accessible care , services provided by
generalist
The Alma-Ata international conference gave primary
health care a wider meaning Primary health care is
essential health care made universally accessible to
individuals and acceptable to them , through their full
participation and at a cost the community and country
can afford.

Principles of Primary health care.

Equitable distribution.
Community participation.
Inter sectoral coordination
Appropriate technology

HEALTH FOR ALL

In 1977, it was decided in the World

Health Assembly to launch a movement
known as health for all by the year
2000. The fundamental principle of
HFA strategy is equity that is an equal
health status for people and countries
ensured by an equitable distribution of
health resources.

CONTI

In 1978, Alma Ata international conference on

Primary health care reaffirmed Health for all as
the major social goals of the Governments and
stated that the best approach to achieve the goal
of HFA is by providing primary health care,
especially to the vast majority of underserved
rural areas.
In 1981, a global strategy for HFA was evolved
by WHO. The global strategy provides a global
framework that is broad enough to apply to all
Member states

MILLENIUM
GOALS.

DEVELOPMENT

September 2000, representatives from

189 countries met at the millennium
summit in Newyork, to adopt the
United Nations Millenium Declaration.
Goals : Area of development and
eradication of poverty.

ISSUES IN
HEALTH CARE
REFORMS.

1. UNEQUAL
DISTRIBUTION
OF HEALTHCARE
RESOURCES
INDIA.

The ratio of hospital beds to population in rural

areas is fifteen times lower than that for urban
areas.
The ratio of doctors to population in rural areas
is almost six times lower than that in the urban
population.
Per capita expenditure on public health is seven
times lower in rural areas, compared to
government health spending for urban areas.

The most peripheral and most vital unit of

Indias public health infrastructure is a primary
health centre (PHC).
In a recent survey it was noticed that only 38%
of all PHCs have all the essential manpower and
only 31% have all the essential supplies (defined
as 60% of critical inputs), with only 3% of
PHCs having 80% of all critical inputs.

Though the spending on healthcare is 6% of gross

domestic product (GDP), the state expenditure is
only 0.9% of the total spending. People using their
own resources spend rest of it. This makes the
Indian public health system grossly inadequate and
under-funded.
Only five other countries in the world are worse
off than India regarding public health spending
(Burundi, Myanmar, Pakistan, Sudan, Cambodia).
As a result of this dismal and unequal spending on
public health, the infrastructure of health system
itself is becoming ineffective.

2. ACCESS
DIFFICULTIES TO
HEALTH CARE.

Geographical distance
Socio-economic distance
Gender distance

Socioeconomic distance

A different aspect of healthcare access problem

is noticed in cases of urban poor.
Urban residents are extremely vulnerable to
macroeconomic shocks that undermine their
earning capacity and lead to substitution towards
less nutritious, cheaper foods.
People in urban slums are particularly affected
due to lack of good housing, proper sanitation,
and proper education

Urban slums are also home to a wide array of

infectious
diseases
(including
HIV/AIDS,
tuberculosis, hepatitis, dengue fever, pneumonia,
cholera, and malaria) that easily spread in highly
concentrated populations where water and sanitation
services are non-existent.
Poor housing conditions, exposure to excessive heat
or cold, diseases, air, soil and water pollution along
with industrial and commercial occupational risks,
exacerbate the already high environmental health
risks for the urban poor.

conti

Lack of safety nets and social support systems, such

as health insurance, as well as lack of property rights
and tenure, further contribute to the health
vulnerability of the urban poor.
Though the healthcare facilities are overwhelmingly
concentrated in urban areas, the socio-economic
distance prevents access for the urban poor. These
socio-economic barriers include cost of healthcare,
social factors, such as the lack of culturally
appropriate services, language/ethnic barriers, and
prejudices on the part of providers. There is also
significant lack of health education in slums.

Gender related distance.

From socio-cultural and economic
perspectives women in India find
themselves in subordinate positions to men.
They are socially, culturally, and
economically dependent on men.
Women are largely excluded from
making decisions, have limited access to
and control over resources, are restricted in
their mobility, and are often under threat of
violence from male relatives.

3. EFFECT ON HEALTH OUTCOME

INDICATORS DUE TO ECONOMIC
INEQUALITY
Healthy living conditions and access to good quality
health care for all citizens are not only basic human
rights, but also essential prerequisites for social and
economic development.
Any inequality in social, economical or political
context between various population groups in a given
society will affect the health indicators of that
particular society.

4. PRIVATE HEALTHCARE AND ECONOMIC INEQUALITY

The growth of private healthcare sector

has been largely seen as a boon, however it
adds to ever-increasing social dichotomy.
The dominance of the private sector not
only denies access to poorer sections of
society, but also skews the balance towards
urban-biased, tertiary level health services
with profitability overriding equality, and
rationality of care often taking a back seat.

The increasing cost of healthcare

that is paid by out of pocket
payments is making healthcare
unaffordable for a growing number
of people. The number of people
who could not seek medical care
because of lack of money has
increased significantly between
1986 and 1995

CONTI

The proportion of people unable to

afford basic healthcare has doubled in
last decade.
One in three people who need
hospitalization and are paying out of
pocket are forced to borrow money or
sell assets to cover expenses.

CONTI.

Over 20 million Indians are pushed

below the poverty line every year
because of the effect of out of pocket
spending on health care.
In the absence of an effective
regulatory authority over the private
healthcare sector the quality of medical
care is constantly deteriorating.

RESEARCH ARTICLE.
A recent World Bank report acknowledges the facts
that doctors over-prescribe drugs, recommend
unnecessary investigations and treatment and fail to
provide appropriate information for patients even in
private healthcare sector. The same report also states
the relation between quality and price that exists in the
private healthcare system. The services offered at a
very high price are excellent but are unaffordable for a
common man. This re-emphasizes the role socioeconomic inequality plays in healthcare delivery.