Outpatient care: Prevention is better than cure

News: Outpatient healthcare is not getting the required attention.

What is outpatient (OP) healthcare and how do OP expenses affect people?

It comprises doctor consultations, drugs, and tests. OP expenses have the majority share in total out-of-pocket (OOP) expenditure on health. As per the government and various representative surveys, OP expenses have a major impact on Indian households compared to IP expenditure.

Why OP care insurance has not been in India yet?

1) Lack of standards 2) Under-regulated OP practices 3) Difficulty to monitor OP clinical and prescribing behaviours 4) Higher chances of malpractices 5) Low public awareness of insurance products 6) Low ability to recognize entitlements and exclusions.

Why there is a need for extending OP care coverage?

First, Inpatient care (IP) consists of high impact and unavoidable episodes, which are costly and urgent. Thus, the majority of insurance coverage is for IP care. Whenever there is a health emergency, OP care suffers the first blow. Thus, the mantra of prevention is better than cure is lost.

Second, it goes against economic sense to prioritize IP care over OP care for public funds. Preventive and primary care services experience low demand and must therefore be incentivized.

Third, positive feedback would mean that greater investment in OP today would translate to even greater investment in IP care in the future. This would further lead to less money investment in OP care.

Why it is important to make note of a few challenges?

First, significant improvements in healthcare are not possible without sufficient finances and time.

Second, there is no perfect model for expanding healthcare. So, emphasis must be on innovation to find the best fit.

Third, implementing even the best fit could involve some drawbacks.

What lessons could India learn from the world?

India could learn lessons from countries like Thailand, which are closer to its socioeconomic fabric than from the USA. The decline in Out Of Pocket expenditure in Thailand was achieved through a Universal, tax-financed, public sector-dominated model of OP care. This calls for systematic, judicious and tiered payment models for OP services.

Private players can be contracted with centralized supervision to deter any corruption.

Source: This post is based on the article “Prevention is better than cure” published in The Hindu on 27th December 2021.