Prof.S.Chakraborty

1
WELCOME

• By
• Prof.S.Chakraborty
• Director
• Jaipuria Institute of Management
• Lucknow, INDIA.

2
GOAL OF DEVELOPMENT

• Social justice
• something that goes beyond
• Economic Growth

3
Development happens through

• Income security
• Securities against contingencies
• Environmental security

4
Shifts in Employment patterns

• To
• Buying service from people.
• Job growth in the unorganized sector

• From
• Having people on rolls
• Job growth in the organized sector

5
Fallouts

• Lack of clear cut employer employee
  relationship
• Increasing income insecurity
• Vulnerability of the workers

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Social Security, social integration and 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.

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Need 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.

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Health 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 13 between the poorest
  20 and the richest 20

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

• 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

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• Promotion of better chances of individual
  development
• Intensifying focus towards needy (contribution
  or no contribution)
• Shifting away from large scale universal systems

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Need of a focus shift in social security

• 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.

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Poverty

• Poverty is not just a state of deprivation.
• It is equally a state of vulnerability

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Market oriented interventions in the health
sector

• Does the assumption of perfect market work?
• Perhaps can work only when those with greatest
  need are also those with most resources

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Key assumptions in market functioning

• Perfect information
• Free entry and exit
• Fair distribution of income with all having an
  ability to pay

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Scenario in Health Sector

• Wide range of market failures because of
• high element of risk and uncertainty
• moral hazard
• adverse selection
• externalities
• assymetrical distribution of income

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The big question

• Does the market oriented health care systems
  actually work?

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Health care through social security schemes

• Displayed characteristics
• Have an urban orientation
• Caters to those in the organized sector

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Employees covered under different system (number
in millions)
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Low income organized sector workers

• 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

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Notable 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

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Typology of Risk Pooling Schemes in India Today
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Quality 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

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Health security

• Requires to ensure low exposure to risk
• Provides access to healthcare services along with
  ability to pay

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Burden of treatment

• Equals
• Cost of treatment loss of income
• However
• Little attention has been paid to the burden
  factor

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Does health insurance answers the need?

• Perhaps yes, for those who can afford to pay when
  they are healthy
• Apparently no, when it comes to the poorer section

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Social security needs in developing 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.

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What does it call for?

• Greater emphasis on social justice and social
  rehabilitation
• not limited to
• only medical rehabilitation.

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Envisaged 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

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Recent 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

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• Efforts of late .
• are in the right direction

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India is on the move showing signs 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.

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As a consequence

• I in India has started changing
• It is no longer
• Immitation and inhibition
• Instead it is
• Innovation and Creation of value from ideas

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• Thank You