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

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

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 Disease/ConditionEstimated cost of treatment of one episode/per year (in Rs.) In terms of days of wages lost to BPL* families Heart disease Diabetes with insulin Cancer Acute case of COPD** Moderate asthma Mood or bipolar disorders Major cases of injury 11,000 5,000 15,000 32,000 16,200 – 20,600 3,000 – 6,000 9,000 333 100 454 969 624 182 273 * BPL: Below poverty limit; **COPD: Chronic obstructive pulmonary disease

10. 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 Key challenges

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

12. 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. Need of a focus shift in social security

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

14. Does the assumption of perfect market work? Perhaps can work only when – those with greatest need are also those with most resources Market – oriented interventions in the health sector

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

16. Wide range of market failures because of - high element of risk and uncertainty - moral hazard - adverse selection - externalities - assymetrical distribution of income Scenario in Health Sector

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

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

19. Employees covered under different system (number in millions) ContributoryNon- contributory Total Mandatory9.113.1822.28 Voluntary18.610.2228.82 Total27.723.4051.1

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 Manda tory Contri bution VoluntaryEmployee s on Mar, 02 (in million) Non – Cont. Contrib ut. Non – Cont. Public sector Employees Government* Other Departments** Quasi-Govt.*** CGHSEHS 10.76 3.62 6.02 Pvt. Sector Employees Low-income # Others ESISEHS INS.EHS,INS 8.50

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