WELCOME

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. From Having people on rolls Job growth in the organized sector To Buying service from people. Job growth in the unorganized sector Shifts in Employment patterns

5. Fallouts • Lack of clear cut employer – employee relationship • Increasing income insecurity • Vulnerability of the workers

6. 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.

7. 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.

8. 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 1:3 between the poorest 20% and the richest 20%

9. Estimates of household expenditures/treatment costs per episode/per year in India

10. 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

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

12. 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.

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

14. 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

15. Key assumptions in market functioning • Perfect information • Free entry and exit • Fair distribution of income with all having an ability to pay

16. 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

17. The big question Does the market – oriented health – care systems actually work?

18. Health care through social security schemes Displayed characteristics • Have an urban orientation • Caters to those in the organized sector

19. Employees covered under different system (number in millions)

20. 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

21. 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

22. Typology of Risk Pooling Schemes in India Today

23. 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

24. Health security • Requires to ensure low exposure to risk • Provides access to healthcare services along with ability to pay

25. Burden of treatment Equals Cost of treatment + loss of income However Little attention has been paid to the burden factor

26. 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

27. 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.

28. What does it call for? Greater emphasis on social justice and social rehabilitation not limited to only medical rehabilitation.

29. 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

30. 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

31. Efforts of late ……. are in the right direction

32. 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.”

33. 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

34. Thank You