kssp19sep10
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KSSP discussion paper
Biju Soman
Human resources challenges in Kerala
Thiruvananthapuram, 19 Sep 2010
Public health challenge
• Overall well-being of the society– public health is the art and
science of achieving this
• Healthcare delivery system– Is a means not the end…– Unparallel increase in costs
Healthcare spending grows much higher
19 Sep 2010 2KSSP HEALTH COMMISSION
Owe Reinhardt, Princeton University, 2009
healthcare cost
• Raising costs– Medical & hospitality services– Equity concerns (elderly)
• Technology adds– Costly diagnostics & treatments
• Multiple players– Lack of coordination (US model)
• No incentives – To reduce costs! Burden is more for the poor
19 Sep 2010 3KSSP HEALTH COMMISSION
*Bodenheimer T. New Engl J Med 358:10 2008; KSSP Study; 2005-06
SES % family income
4 31.7
3 18.1
2 13.0
1 10.4
Technology can bring down cost
• e-Health initiatives– EMR & EHR for better documentation– e-Reference– Digital X-rays (Narayana Hrudayalaya)– e-kiosks in rural areas (Aravind Eye hospital)– Universal Spectacles (VisionSpring)– Teamlet model– e-consultations– HIMS models
Easy to adjust refractory power
19 Sep 2010 4KSSP HEALTH COMMISSION
Bhattacharyya et al. Health Research Policy and Systems 8:24. 2010
Healthcare gets attention
• More inputs from GoI
• the saga of NRHM
• Uptake in Health Insurance
• RSBY (CHIS)
• Corporate and Private health establishments
• But…
PHC Punnayur
19 Sep 2010 5KSSP HEALTH COMMISSION
Becomes costlier
• Disruptive Financing – Quantity of contacts/procedures
• Crisis in health insurance – Overbilling, moral hazards– Payout Ratio more (70%)
• No incentives to bring down costs– Why should we?
19 Sep 2010 6KSSP HEALTH COMMISSION
future Managed care initiatives
An organization assumes responsibility for all necessary health care for an individual/family/community in
exchange for a fixed payment
• yearly premium for sufficiently long duration
• profit increases by avoiding catastrophic events
• strict monitoring by an independent agency
19 Sep 2010 7KSSP HEALTH COMMISSION
A paradigm change
19 Sep 2010 8KSSP HEALTH COMMISSION
The paradigm change
Smith, R. BMJ 1997;314:1495
future Managed care initiatives
• Consumer education• Standard protocols• Better HIMS• Optimal use of professionals• Newer technologies• Harness support from other sectors (education,
agriculture, transportation, social welfare, etc)
Client participation,
trans-disciplinary approaches,
equity
Primary Health Care
19 Sep 2010 9KSSP HEALTH COMMISSION
Smith R. BMJ 1997;324:1495
19 Sep 2010 10KSSP HEALTH COMMISSION
Four suggestions
Grass root level workers
Doctors and specialists
Supervision & surveillance
Medical(Health) Education
Junior Public Health Nurses
• Empower them
• Respect them and bring respect to them
• Have major role to play
19 Sep 2010 11KSSP HEALTH COMMISSION
HIMS initiatives of SCTIMST
• ASA initiative– Customized DHIS software (CHC Vizhinjam)– Runs in over 1000 health centers in Kerala)– Formats got revised at national level– Reporting through mobile SMS
• Coming up– Customized laptops for field staff (JPHNs)– Individual module (EHR)– Multi-touch screen computer kiosks– Preventive cardiology initiative
19 Sep 2010 12KSSP HEALTH COMMISSION
19 Sep 2010 13KSSP HEALTH COMMISSION
Geo-referenced maps of field areas
19 Sep 2010 14KSSP HEALTH COMMISSION
Geo-referenced maps of field areaClearly delineates coastal overcrowding
19 Sep 2010 15KSSP HEALTH COMMISSION
Uses Open Source SoftwaresCost ~ Rs 15000
Pilot testing of its use for JPHNs is planned
19 Sep 2010 KSSP Health Commission 16
One health worker per ward Pool up JPHNs, JHIs & junior-grade supervisory
officers, if necessary
5 days in the field and one day at PHC Let them work with ASAs, Anganwadi teachers, etc
Provide laptops with Geo-referenced field datasets to all HWs
Can help in Computer registration of patients at PHC
Doctors
• Better parity in salary (public & private)•Thailand experience
• Better incentives for working in rural areas•Tamil Nadu experience
• Zonal recruiting and posting
• Better working environment for specialists•Convert TLQ hosp into Single/Two Specialty centers•Comprehensive 24 hour services including emergency services•Rotation OP clinics by specialists in the nearby PHC/CHCs
19 Sep 2010 17KSSP HEALTH COMMISSION
Supervisory Cadre
Better MonitoringMulti-touch screen kiosks in district offices
Real time monitoring of epidemicsTechnical support from Medical Colleges
Research wing (Health System Research) within health services
19 Sep 2010 18KSSP HEALTH COMMISSION
Medical(Health) Education
National Council for Human Resources
National and state level accreditation
Multi-disciplinary approaches
19 Sep 2010 19KSSP HEALTH COMMISSION
Recap• Healthcare challenges
• Cost containment
• Technical solutions
• Managed care settings
• Let’s aim at overall wellbeing
Thank You19 Sep 2010 20KSSP HEALTH COMMISSION
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