india potential role for disease management in the indian healthcare system, & the role of...

India Potential role for Disease Management in the Indian Healthcare System, & the

Role of private sector companies in its development

Disease Management Leadership Forum, DMAA, Las Vegas , USA . September 17th ,2007

Rajendra Pratap GuptaVice Chairman

Heartline Telemedical Services Pte Ltd.India

© Rajendra Pratap Gupta. E-mail- [email protected]

http://www.crwflags.com/fotw/images/i/in.gif

Total area 1.27 Sq.Mi - About 1/3rd the size of US

Total Population 1.1 Billion

Density 324 / Sq. Km

Annual Population Growth 1.3 %

Urban Population 27.8 % Rural Population 72.2 %

India – Some Facts

© Rajendra Pratap Gupta. E-mail- [email protected] Source : U.S. Deptt. of State .http:/www.state.gov/r/pa/ei/bng/3454.htm

mailto:[email protected]

GDP (FY 2005-06) $797 Billion

Real growth rate (FY 2005-06) 8.4 %

Per capita GDP (FY 2005-06) $761

India occupies 2.4 % of the world’s land area, it supports 15% of the world’s population


© Rajendra Pratap Gupta. E-mail- [email protected] Source : U.S. Deptt. of State .http:/www.state.gov/r/pa/ei/bng/3454.htm


Percentage of Population under age 15 Years –2002 33 %

Percentage of Population over age 65 Years –2002 5 %

Percentage of Population living in Urban areas –2000 28 %

Average Total Fertility rate (2000-05 ) 3

Life Expectancy at Birth (Years) 2000-05 Female 65 / Male 64


© Rajendra Pratap Gupta. E-mail- [email protected] Source : World Resources Institute. http:/earthtrends.wri.org.


Infant Mortality Rate per 1,000 live births 64.5

Maternal Mortality Ratio per 100,000 live births 540

Median age of total Population 24.5


© Rajendra Pratap Gupta. E-mail- [email protected] Source : UNFPA . http:/www.unfpa.org/profile/india.cfm

Population living below $ 1 / day , Per Cent 44.2

Illiteracy Rate of the Population , Per Cent 31.75


Physicians ( Density per 1000 population ) 0.60 (2004)

Nurses ( Density per 1000 population ) 0.80 (2004)

Midwives ( Density per 1000 population ) 0.47 (2004)

Dentist ( Density per 1000 population ) 0.06 (2004)

Pharmacists ( Density per 1000 population ) 0.56 (2003)


© Rajendra Pratap Gupta. E-mail- [email protected] Source : WHO . http://www.who.in/whois/databases/core/core_select_process.cfm

Hospital Beds ( Density per 1000 population) 0.70 (2002)


Total Expenditure on Health as a Percentage of GDP 5.0

General government expenditure on Health as a percentage of total Expenditure on Health 17.3

Private expenditure on Health as a percentage of total Expenditure on Health 82.7

General government expenditure on Health as a percentage of total government expenditure 2.9


© Rajendra Pratap Gupta. E-mail- [email protected] Source : http:/www.who.int/whois/database/care/core_select_process.cfm. Year 2004 * Frost & Sullivan 05

Spending on Health by household as a percentage of total Expenditure 8.2*


Per Capita total expenditure on health at average exchange rate (US $ ) 31.4

Per capita government expenditure on Health at average exchange rate (US $ ) 5.4


© Rajendra Pratap Gupta. E-mail- [email protected] Source : http:/www.who.int/whois/database/care/core_select_process.cfm. Year 2004

Out –of-pocket expenditure as a percentage of private expenditure on Health 93.80

Private Health Insurance coverage as a percent of population 2%


© Rajendra Pratap Gupta. E-mai: [email protected]

Government Private Sector

Provides Healthcare services free of cost to mostOf the people

Provides majority of Healthcare services and funding

Healthcare Services

Indian Healthcare System



Why Disease Management is required in India


Out –of-pocket expenditure as a percentage of private expenditure on Health is 93.80 %

75.3 % of the Children( Below 3 Years in Age ) in Rural areas & 70.8 % in Urban area are Anaemic

Two persons die of TB every minute. More than 1000 die every day

There are 2 –2.5 Million new patients of Cancer every year

53 % of all deaths are due to NCD’s

India – Why Disease Management



© Rajendra Pratap Gupta. E-mail- [email protected] Source : Annual Report 2006-7, MOHFW,GOI

Government Expenditure on Health

1.28 1.391.61

1.93

2.4

0

0.5

1

1.5

2

2.5

3

FY 2002-03 FY 2003-04 FY 2004-05 FY 2005-06 FY 2006-07(RevisedEstimate)

US $ Billion



Population distribution age wise –Year wise

341.8 342.4 342.8 342.9 342.7 342.3

605.2 618.4 631.6 644.7 657.8 670.9

65.3 66.9 68.6 70.5 72.5 74.6

0

100

200

300

400

500

600

700

800

2000 2001 2002 2003 2004 2005

Pop

ulat

ion

in M

illio

n

0-14 Years 15-60 Years 60 Years +


© Rajendra Pratap Gupta. E-mail- [email protected] Source: Annual Report 2006-7, MOHFW, GOI

Projected deaths by cause,30-59 Years ,2005

9%

25%

9%30%

2%

17%8%

Cancer

CardiovascularDisease

Chronic RespiratoryDisease

Communicable,Maternal &Perinatal,NutritionalDeficienciesDiabetes

Injuries

Other ChronicDiseases


Doctor patient ratio

> 30 % population is illiterate

Problem compounded by lack of trained pharmacists

Health awareness is an issue with rural population

Indians are genetically predisposed to CVD & Diabetes




Of All the patients who are prescribed Medicines*

1/3rd take the drugs as told

1/3rd comply only partially

1/3rd do not comply at all

2/3rd Patients need disease management programs


© Rajendra Pratap Gupta. E-mail- [email protected] Source: Study conducted by The Tribune – NCR Edition

50% of the medicines prescribed are not taken at all – WHO



Disease Management Program of the Government of India


Modified Leprosy Elimination Campaign ( MLEP )

Package of IEC & MDT

SAPEL for Rural , LEC for Urban areas & NGO’s were involved

9,90000 new patients were brought under this program between 1997-2003

National Leprosy Eradication Program - NLEP

© Rajendra Pratap Gupta. E-mail- [email protected] Source : Source : Annual Report 2006-7, MOHFW,GOI


More than 8.5 Million cases of TB

1/5th of new cases worldwide are from India

RNTCP launched in 1997 March. By 2006 March 1114 Million people were covered

Includes training material for staff, 11,800 diagnostic centres

Treated 6.30 Million patients.

National TB control Program - RNTCP


Treatment Success rate increased from 25 to 85 %. Death rate reduced from 29 to 4 %


2.-2.5 Million Cancer patients

NCCP launched in 1975-6.

Regional Cancer Centers, Development of Oncology wing, DCCP, DNGO’s

IEC, Cancer Awareness Day , National Strategy task force

National Cancer Control Program - NCCP


Onconet India

1st HIV patient detected in 1986. In 2005, 5.2 Million patients

85.8 % transmitted through Sexual infections

39 % of the patients are women

101 ART Centers in 29 states

National Aids Control Program -NACP


52663 patients were put on free ART

10 Million patients without proper treatment

1 Psychiatrist for every million population

NMHP includes IEC

Strengthening of Hospitals

National Mental Health Program


National Program for Prevention & Control of Diabetes , CVD & Stroke - NPCDS


0

500000

1000000

1500000

2000000

2500000

3000000

3500000

Cancer CVD Diabetes RespiratoryDiseases

Deaths in 2005

Prevalence of CHD was 9.6 % in Urban & 3.74 % in Rural - 1996

1.5 Million die of CHD every year

NPCDS pilot started in 2006-7

Integrated approach

Reduce prevalence of risk factors



Reduce morbidity and mortality

Build capacity of the Healthcare system

Prevention through Health Promotions & establish guidelines

Setting up of National NCD cell, 6 RRC’s & State NCD cells

IEC strategy




Disease Management Program in Private Sector

Basically are Patient Relationship Programs

Covers Diabetes, Cancer , Neuropathy pain, Glaucoma, Obesity , Arthritis, Erectile Dysfunction & Renal impairment

Cost of the DSM program is borne by the pharmaceutical companies

Services include call center helpline, onsite Counselors, Physiotherapists & Phlebotomist

The organization has been providing service for the last 6 years across 22 towns

DSM company A



Disease Management Program in Insurance Sector

© Rajendra Pratap Gupta. E-mail- [email protected] Conversion : Rs.4100 Crore = 1 Billion US$ Source: IRDA, Weighted New Business Premiums for

individual business

The industry has seen an unprecedented growth during the current year

YOY Growth – Health Insurance Industry

29

16% 17%

34%

132%

0%

20%

40%

60%

80%

100%

120%

140%

FY 2004 FY 2005 FY 2006 FY 2007 ( 09Months )

© Rajendra Pratap Gupta. E-mail- [email protected] Source: IRDA, Weighted New Business Premiums for individual business

YTD Dec FY07

Others, 9.4%Reliance Life*, 4.2%

Tata AIG, 4.5%

Birla SunLife, 5.3%

Aviva Life, 5.3%

Max NYL, 6.7%

SBI Life, 7.6%

ICICI - Pru, 29.1%

Bajaj Allianz , 18.3%HDFC Standard,

9.5%

Market share: Private retail

Private market size – US$ 1.92 Billion


Diabetes Care Proposition – Private Co.

Partnerships with wellness providers

Reminders for testing & Home collection of samples

Web support to facilitate self-management

Co-promotion of support groups

Free regular check-ups & annual consultations

Reduction of premiums based on control

Diabetes Care


Insurance Company – Private Sector

• Diabetes Care: First ever critical illness plan for Diabetics

– Provides financial support to meet cost of complications

– Incentive for compliance through premium reduction

– Wellness proposition through partnerships

– Balance between cost, quality and access to diabetes care


Incentives for control

Age bandPremium reduction

(Level 3)Premium increase

% diff in Premium (best & worst

control)

25-35 15% 10% 29%

36-50 20% 15% 44%

>50 30% 17.5% 68%

33

Launched in August 2007

Plans to cover 1-2 million lives in the next 2-3 years

Prevention and Wellness programs for its customers

Health Insurance company B


Launched in August 2007

Plans to cover Elderly . Premiums @ US$ 121 for a cover of US$ 2439

No pre-acceptance medical screening . Covered for life.

Health Insurance company C


Those who have no illness. Get ‘Good Features Discount’ @ 10 %

Diabetes Safe Policy is meant for known Diabetics. Annual Premium starts @ US$ 20

Currently in the fifth year

Till date 9309937 lives have been enrolled

This year the enrolments have been 2.22 Million lives

1st & 2nd year premium US$ 1.46 / year & from 3rd Year US$ 2.92

Covers all pre-existing illnesses

Innovative Scheme launched by a Hospital


Till date there has been 345854 free OPD consultations and 84721 surgeries

Self funded scheme and is being piloted in the state of Karnataka

The Governments plays the role of Risk Manager

Focus is on early diagnosis through regular health camps


The Scheme is targeted at the lower strata of the society

Innovative Scheme launched by a Hospital

Private companies act as Initiators & Innovators

Government steps in as a growth catalyst and later as a regulator

Finally big corporations & MNC’s to dominate the industry

The Way Forward………


The rising healthcare costs coupled with a huge population

Increasing incidence of NCD’s

Increased Healthcare spending by the government

The Way Forward………


Disease state management is the best way forward for India

Rajendra P. GuptaE-mail: [email protected]: +91-9867300045 +91-9323109456

Thank You !


india potential role for disease management in the indian healthcare system, & the role of...

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