Health

What is health?
Health is defined as a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity (WHO, 1948 cited
in WHO, 2006).
Health can be viewed positively or negatively. (Tones and Green (2004)).

Positive approaches to defining health, and

Negative approaches to defining health.

When health is viewed in a more positive way definitions tend to be broader

and take into account concepts such well- being.
The World Health Organization definition outlined earlier is an example of a
more positive definition and marks a shift in understanding away from a more
narrow, medical and negative view of health.
When health is viewed in a negative way, then definitions will tend to focus
on health as illness.

Laveracks explanation for wellbeing

He separates well- being into three different types physical, social and
mental.
1. Physical well- being is concerned with healthy functioning, fitness and
performance capacity,
2. Social well- being is concerned with issues such as involvement in
community and inter- personal relationships as well as employability and
3. Mental well- being involves a range of factors including self- esteem and
the ability to cope and adapt.
.A further concept that is arguably related to how health may be perceived in
quality of life.

The Constitution of the World Health Organization of 1946 first held up

health as a human right in the statement the enjoyment of the highest
attainable standard of health is one of the fundamental rights of every
human being (cited in WHO, 2008a: 5).

Who provides
health care?

Emphasis on the development of government-owned health services, largely

financed by government tax revenues.
Over most of the period since the second world war, attention has focused
on how to plan and develop these public investments.
This concern gave rise to new strategies for health care resource allocation,
such as the primary health care approach, the child survival and
development revolution, and, most recently, the emphasis by the World Bank
on the most cost-effective essential package of health services (World
Bank, 1993).

Throughout this period, most of the attention has focused on how to make
the public sector health care services work better.
The intense scrutiny given to public sector health financing and provision
strategies persisted despite a steady flow of evidence that private health
care supply was significant and growing rapidly in many countries
Much of this evidence was indirect, emerging from household survey data on
health care use and expenditure patterns.
These data often showed that, despite public policies promoting universal
access to subsidized public services, the majority of health care contacts
were with private providers on a fee for service basis

Private health care is often significant for rural as well as urban populations
and for lower income groups as well.
This indirect evidence indicates that, despite decades of public investment
to assure public provision for basic services, private provision is significant
and often dominant for many of these services.

Private providers
It is conventional to define private providers as those who fall outside the
direct control of government (Bennett 1992). Private ownership generally
includes both for-profit and non-profit providers.
For example, private ownership would include health care facilities owned by
individuals who seek to earn profits, clinics and hospitals owned by private
employers, and those operated by religious missions and other nongovernmental organizations (NGOs).

What do we mean by
provider?
Providers may be individual practitioners, groups of practitioners, or facilities
(e.g. clinics, hospitals, or other institutions).
Services are usually provided by doctors, paramedical health workers (e.g.
clinical officers, registered medical practitioners, physiotherapists), or nurses.
Although countries differ in their training requirements for specific
categories of health care provider, information on training differences is not
readily available.

Relationship between countrys

income and health care services
As a countrys income increases, more resources are available to purchase health services of
all types, including those provided in the private sector, so that we would expect to find the
supply of private providers increasing with income.
But will private providers increase at a higher or lower rate than the rate of increase of
income? And do private providers increase at a faster rate than the supply of public
providers?
These show that the supply of private physicians appears to be income elastic: a 10%
increase in income is associated with a 16.4% increase in the number of private physicians
per million.
In contrast, the same increase in income only leads to a 9% increase in the supply of public
physicians.
Private physicians are a luxury good, and as income increases, a greater share seems to be
spent on private physicians; the share of income spent on public physicians is about constant.

The rate of increase of private physicians with income exceeds that of public
physicians that at levels of income above around US$7,500, private
physicians actually exceed public ones.

Health system
Ahealth system, also sometimes referred to ashealth care
systemorhealthcare system, is theorganizationof people, institutions,
and resources that deliverhealth care services to meet thehealthneeds of
target populations.
Health and socio-economic developments are closely related to each other.
While Economic development is gaining momentum over the last decade,
health system is at crossroads.
Even though Government initiatives have recorded some noteworthy
successes over time, the achievements are just moderate compared to the
international standard.
India ranks 118 among 191 WHO member countries on overall health
performance.

Total expenditure on health Rs.110,000 Cr, which is 5.2% of our GDP.

Public health investment has declined from 1.3% of GDP to 0.9% by 2001.
Govt share of the total expenditure is only 17%.
Central budgetary allocation for health has remained static at 2.3% of the
total central budget.
State budgetary allocation have declined from 7% to less than 5.5% in many
states.
Many states do not have a clear health policy. There is no systematic effort
at the state level to plan, and monitor the delivery of health services.

According to WHO report, Investing in health for economic development

by Jeffrey Sachs and Manmohan Singh (2001) , suggests that for developing
countries like India, health policies should focus on:
1. Scaling up the financial resources. (ex: Partnership)
2. Tackling the non-financial obstacles in service-delivery.

Public health infrastructure

Between 1950 and 2000, the rural health infrastructure has gone up from 725
facilities to 163,000 [Mavankar and Ramani, 2005], consisting of 4000 rural sub
district hospitals, 24,000 primary health centers, 135,000 sub health centers.
Yet the access of public health facilities is very poor for women , children and
the socially disadvantaged sections of our society. Because of the following
reasons:
1. Non-availability of staff.
2. Lack of accountability of quality of care.
3. Poor logistics management of supply of medicines.
4. Also, past unsatisfactory performance of our public health system in rural
areas is forcing the poor to seek healthcare from the private sector.

Private health care

Private sector accounts for 67% of the total number of 30,000 hospitals and
33% of the total number of 10,00,000 beds, 60% of the 5Million doctors in
the country.

Based on the above estimates of public and private healthcare

infrastructure, India has only about 100 beds per 1,00,000 population against
the WHO norms of 300 beds per 1,00,000.
The number of doctors per 1000 population is also well below the WHO
norms.
The demand-supply gap is therefore large.
Investment required to bridge the gap in the next 10years could range from
Rs.100,00 Cr to Rs.140,000 Cr.
This sector can create a huge income and employment growth in the next
10years.

Affordability
Utilization of public health care facilities is only about 20% for outpatient
services and 40% for inpatient services.
Hence poor patients are forced to seek health care services from the private
sector by paying high fee.
Health insurance is one option to address affordability.
Health insurance schemes like Yeshasvini, Arogya Bhagya, Employee State
Insurance (ESI) scheme are found helpful.
Govt should facilitate more growth of such schemes to improve affordability.

Access
Access to services is an equally important determinant in meeting health
care need of the people, especially those in the rural areas.
Ambulance services are usually rare, private transport is expensive.
Not much access to telephone communications.
Effective use of regular mobile telephone can also improve access and
quality of health care in rural areas.