Mr Girish Rao

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Role of Health Insurance in Healthcare Safety

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Role of Health Insurance in Healthcare Safety:

Role of Health Insurance in Healthcare Safety Striking Win - Win Partnerships Mr. Girish Rao

Patient Safety : A Public Health Risk:

Patient Safety : A Public Health Risk Status The Relative RISK : Deaths Per 100 Million Hours Being pregnant 1 Traveling by train 5 Working at home 8 Being in traffic 50 Flying on a commercial airplane 100 Being hospitalized 2000 A PROBLEM EVERYWHERE!! Source : WHO

Why Partnerships?:

Households Third Party Payors Care Providers Treatment Direct Out of Pocket Payment Paying for health care User Charges Private Insurance Premiums Social Insurance Taxation Reimbursement Prospective Retrospective Private Insurance Government Insurance Social Insurance HUGE INTERDEPENDENCY BETWEEN STAKEHOLDERS !! Why Partnerships?

Why Partnerships?:

Brazil Chile India Pakistan Germany Singapore Spain Sweden USA UK Total expenditure on health as % of GDP Out of pocket expenditure as % of total expenditure on health 1 5 10 15 10 30 50 70 90 Graph showing health expenditure of countries in the year 2008 Source - Statistics from WHO Why Partnerships?

Risk Management:

Risk Management Financial Risk Clinical Risk Liability Risk Resource Utilisation Adverse Outcome Patient Provider Interaction Health Insurance ?? Does Health Insurance have a Role in Health Safety?

Drivers of Health Safety:

Drivers of Health Safety Health Insurance could have a Role in Health Safety?

Patient Safety Focus:

Patient Safety Focus How can health insurance impact all of these ?

Health Insurance Focus:

Health Insurance Focus

Health Insurance Focus:

Health Insurance Focus

Health Insurance Process:

Health Insurance Process

Health Insurance Process:

Health Insurance Process

HI Measures: Promote Quality:

HI Measures: Promote Quality

Challenges:

Challenges Provider tiering No standardisation to enable provider classification into tiers based on cost and quality performance Can tiering be related to physical infrastructure without it really affecting health outcomes? Multifactorial Quality of care is influenced by many physician, patient, health care system and environmental factors Lack of Evidence based research Abscence of protocols Regulation Payor and Provider are separate entities with completely different aims and objectives State and Centre (authority / legislation)

HI Measures : Promote Value Based Purchasing:

HI Measures : Promote Value Based Purchasing

Challenges:

Challenges Lack of Valid, Reliable, and Important Performance Indicators Many areas of medical practice suffer from large uncertainties about the best approaches Multifactorial nature of quality of care Lack of Comprehensive Performance Indicators Even if performance can be gauged accurately in some areas, comprehensive performance measurement may not be possible or may be too costly to obtain. If such assessments are not comprehensive, provider organizations and physicians may focus on improving their performance in the areas that can be measured and neglect areas that are not examined or rewarded

Challenges:

Challenges Prescriptiveness or Lack of Flexibility of Performance Measures Process measures may use considerable detail to specify how patients should be treated in specific circumstances Unintended consequences Pay-for-performance initiatives that provide incentives for good performance on a few specific elements of a single disease or condition may lead to neglect of other, potentially more important elements of care for that condition or a co morbid condition Healthcare providers who are monitored by such limited criteria have a powerful incentive to deselect (dismiss or refuse to accept) patients whose outcome measures fall below the quality standard and therefore worsen the provider's assessment

Discussion:

Discussion Multiplicity of Stakeholders Complexity of Interactions Challenge to maintain balance in ecosystem Do we have a mature health care system to sustain this? Short term Contrarian Objectives

Thank You:

Thank You Mr. Girish Rao

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