31 May 2024: UPSC Exam Comprehensive News Analysis

E. Editorials

Category: HEALTH

1. India and the ‘managed care’ promise

Syllabus: GS-2, Issues Relating to Development and Management of Social Sector/Services relating to Health

Mains: Managed Care Organisations (MCOs) as a gamechanger in  universal health coverage (UHC)

Introduction:

• Health Insurance in India: Health insurance has become a key modality for universal health coverage (UHC) in India, bolstered by the digital revolution.
• Managed Care Organisations (MCOs): A healthcare chain in South India announced its entry into comprehensive health insurance, combining insurance and healthcare provision under one roof, akin to the U.S. managed care organisation (MCO) model.

Background of MCOs:

• Origins in the U.S.: MCOs originated from prepaid healthcare practices in the U.S. in the 20th century, gaining momentum in the 1970s due to cost containment concerns.
• Evolution: MCOs fused insurance and healthcare provision, focusing on prevention, early management, and cost control, with a fixed premium paid by enrollees.
• Impact: Although evidence on improving health outcomes is mixed, MCOs helped reduce costly hospitalisations and associated expenses.

Indian Health Insurance Landscape:

• Development: Since the 1980s, Indian health insurance has focused on indemnity insurance and covering hospitalisation costs.
• Market Gaps: Despite a $26 billion market for outpatient consultations, innovation has been limited, and operating costs are high.
• Challenges: Insurance targets urban, well-off segments, with informal outpatient practices and a lack of accepted clinical protocols.

Potential and Challenges for MCOs in India:

• Contrast with the U.S.: MCOs in developing nations typically cater to urban, high-income groups and require strong financial, managerial, and infrastructural capabilities.
• Indian Context: Limited incentives for consumer-driven cost control and unaffordable premiums hinder the systemic push towards managed care.
• Opportunities: Large healthcare brands with loyal urban patient bases may succeed, but purely private initiatives are unlikely to contribute significantly to UHC.
• Public Support: Managed care could be explored with cautious public patronage, focusing on early interventions and comprehensive outpatient care coverage.

Future Prospects:

• NITI Aayog Report (2021): Endorsed an outpatient care insurance scheme based on a subscription model for better integration and cost savings.
• Ayushman Bharat Mission: Incentives for hospitals in underserved areas could be extended to MCOs, catering to PMJAY patients and private clients initially on a pilot basis.
• Sustainable Solution: A well-functioning managed care system can streamline management protocols, consolidate practices, and emphasise preventive care, contributing to outpatient care coverage and UHC over time.

Conclusion:

• Complexity of UHC: No single solution can address all the complexities of UHC, and every solution may introduce new challenges.
• Role of MCOs: While not a perfect solution, MCOs can be part of the broader strategy needed to improve Indian health care today.

Nut Graf: Managed care organisations (MCOs) hold the potential for advancing India’s universal health coverage (UHC) by integrating insurance and healthcare provision, focusing on preventive care, and reducing costs, though public support and cautious implementation are crucial for their success.

2. The tobacco epidemic in India

Syllabus: GS-2, Issues Relating to Development and Management of Social Sector/Services relating to Health

Mains: Reason for high tobacco consumption in India and steps to reverse it

Overview of the Tobacco Epidemic in India:

• Preventable Cause of Death: Tobacco is the most widely recognised preventable cause of disease and death globally.
• High Consumption: India has the world’s second-highest number of tobacco consumers (around 26 crore as of 2016-2017).
• Health Risks for Workers: Over 60 lakh people employed in the tobacco industry are at risk due to the absorption of tobacco through the skin.
• Environmental Impact: Tobacco cultivation depletes soil nutrients, requires more fertilizers and contributes to deforestation (5.4 kg of wood for 1 kg of tobacco).
• Economic Burden: Tobacco production and consumption result in significant economic losses (₹1.7 lakh crore in 2017-2018) and cleaning up tobacco waste costs approximately ₹6,367 crore annually.

Current Status of Tobacco Use:

• Global Adult Tobacco Survey (GATS), Global Youth Tobacco Survey (GYTS), and National Family Health Survey (NFHS) monitor tobacco use.
• Decreasing Use: Overall tobacco use has declined, except among women, where it increased by 2.1% from 2015-2016 to 2019-2021.
• Data Gap: No surveys conducted post-COVID-19 pandemic.

Awareness and Control Programs:

• Framework Convention on Tobacco Control (FCTC): India is a signatory, aiming to reduce tobacco usage globally.
• The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply, and Distribution) Act (COTPA 2003): Law governing tobacco production, advertisement, and consumption with 33 sections.
• National Tobacco Control Program (NTCP): Launched in 2007 to improve COTPA implementation, awareness, and cessation support.
• Taxation and Regulation:
  • Poor Implementation: Smokeless tobacco products (SLTs) are often non-compliant with packaging guidelines, and smuggled products are poorly regulated.
  • Outdated Fines: Fines for COTPA violations have not been updated since 2003.
  • Surrogate Advertisements: Indirect advertisements continue to promote tobacco use.

Challenges and Recommendations:

• Legislative Amendments: Proposed changes in 2015 and 2020 to address surrogate advertisements, fines, and licensing were not passed.
• NTCP Effectiveness: Insufficient staffing, resource allocation, and monitoring have hampered NTCP’s effectiveness.
• Tax Measures and Evasion:
  • Low Tax Rates: Current tax rates (51% for cigarettes, 22% for bidis, 64% for SLTs) are below FCTC’s 75% recommendation.
  • Lobbying and Evasion: High taxes lead to evasion, smuggling, and illicit manufacturing. The tobacco industry lobbying influences governance and exemptions.
  • E-cigarettes: Despite the 2019 ban, e-cigarettes remain a public health challenge.

Way Forward:

• Stringent Implementation: COTPA, PECA, and NTCP need stricter enforcement.
• Increased Taxes: Align tobacco taxes with FCTC recommendations, inflation, and GDP growth.
• Alternative Crops: Support for tobacco farmers to switch to alternative crops like Jowar, which offers higher returns on investment.
• Up-to-date Data: Continuous data collection is essential to stay ahead of the tobacco industry’s evolving strategies.

Nut Graf: Tobacco use in India poses severe health, environmental, and economic challenges, with ineffective implementation of control measures exacerbating the issue. Strengthened enforcement, increased taxation, and alternative farming support are crucial for mitigating tobacco’s extensive detrimental impacts.