THIRUVANANTHAPURAM: With the cost of drugs and diagnostics contributing a major share to the spiraling healthcare expenditure, the insurance system that caters just to hospitalisation may not be the answer, opined most of the experts who participated in the a one-day national consultation on health insurance in India.Shaktivel Selvaraju, health economist with the Public Health Foundation of India, citing the National Sample Survey data, said that most of the catastrophic expenditure on health was not due to hospitalisation but outpatient expenditure such as drugs and diagnostics.The one-day consultation aimed at understanding practical issues in health financing reforms, was jointly hosted by Health Systems Research India Initiative (HSRII) and Health Economics Association of India (HEAI).Talking about the present scenario of health insurance in India and the emerging issues, Planning Board vice-chairman K M Chandrasekhar and Indian Institute of Management-Bangalore faculty member Gita Sen pointed out examples from various parts of the country where most of the money went to corporate hospitals.‘’The explosion of super-speciality hospitals has happened obviously because there is demand and also because of failures in public system, of which people got disenchanted. But there has to be an integrated framework for care, where the tertiary care doesn’t run away with all the resources,” said Gita Sen. Raman Kutty, professor at the Achutha Menon Centre for Health and Social Sciences, discussing the challenges in implementing the health insurance mechanisms said that it would be difficult to bring in the three components of coverage, quality and cost-containment into insurance schemes. “Only two of the components can be brought into any insurance scheme. If there is coverage and quality, cost will not be contained and if there is coverage and cost-containment, then quality will suffer,’’ he said.D Varatharajan, health economist with the World Health Organisation, called for a system of cashless insurance to prevent endless postponement of treatment. ‘’A patient having to spent out of his pocket and then getting reimbursed will not serve the purpose,’’ he said.Varatharajan also called for an integration of public and private providers of healthcare and giving a monitoring role for the community. “Insurance, if not well-done can boost the cost of care for the uninsured. It should also not serve as a vehicle to take health care to the private sector,’’ he said. The consultation had a brainstorming session on the inferences from research studies from Kerala and Gujarat on the existing schemes such as the RSBY and how to design an effective health financing strategy for Kerala.
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