SEOUL/NEW DELHI: India is looking at the South Korean model for Prime Minister Narendra Modi’s flagship universal healthcare programme, Ayushman Bharat, much in line with the government’s inclination to look at development models in east Asian countries rather than Europe or the US.The country has already borrowed important lessons from different countries for its 10-month-old Ayushman Bharat national health insurance scheme, but is now looking closely at South Korea’s universal healthcare programme, which covers primary, secondary and tertiary healthcare, for inspiration.“We have a proposal to study South Korea’s technological innovations in their universal healthcare programme,” said Indu Bhushan, CEO at Ayushman Bharat. “A team would be visiting soon.”ET takes a look at why Modi administration is looking at its newest international trade partner South Korea in the health insurance sector:THE SOUTH KOREAN MODELWhile India launched Ayushman Bharat, which is termed as world’s largest health insurance scheme, in 2018, South Korea is one of the earliest countries to ensure universal healthcare through an Act of Parliament. It enacted Medical Insurance Act in 1963 and started contributive medical insurance programme for employees of large companies. Gradually by 1988, this scheme was extended to local medical insurance in rural areas. In 1999, South Korea enacted National Health Insurance Act and within a year established National Health Insurance Service (NHIS) to bring in a singlepayer healthcare system.About 97% of the Korean population is covered by a contributory health insurance scheme and the rest 3% poorest of the poor segment is under government public health insurance scheme. The country is ranked first in healthcare access among high-income OECD countries.The poorest of the poor do not pay and are managed through the Medical Aid Programme, which is financed by the central and local governments, but administered (including payments to providers) through the health insurance system. Be it cancer screening or a small illness, Medical Aid provides free treatment and reimburses the provider.NHIS under the health ministry oversees the contributory scheme, which has different procedures for employees and self-employed insured. The employee’s contribution depends on his income and varies between $20 and $6,000 per month. For the self-employed, declared income, immoveable assets, age, property and vehicle ownership and gender are taken into account before deciding the monthly insurance contribution. It varies between $11 and $3,000 per month.Every year, NHIS and heads of six types of institutions – hospitals, clinics, oriental medicine, dental clinics, pharmaceuticals, and maternity hospitals – sit across the table in May to decide fee schedules of each healthcare facility and procedures. These are declared in June. In case, negotiations fail, a high-level committee under the health ministry declares them. These fee schedules are uniform and effective for a year.“We have changed our system over the years,” Inseok Yang, general manager of NHIS’ department of international relations and cooperation, told ET. “When we started, healthcare providers, just like in India, did not want to join it. But gradually they realised that most of the people were going to empanelled healthcare centres. This changed their attitude.Now we have a uniform fee system and all hospitals are part of the scheme.”One of the biggest successes of Korea’s universal healthcare programme, according to Yang, has been the technological interface. It is a paperless system that has data of 50 million people accumulated over decades. For the user – both healthcare providers and beneficiaries – it means glitchfree insurance claims. The claim is electronically processed by Health Insurance Review and Assessment Service (HIRA), which reviews for any frauds or abuse. The results are relayed electronically to NHIS, which provides the reimbursements. If India’s National Health Agency reimburses hospital bills within 15 days, NHIS verifies and reimburses the claims on the same day. “We have kept an official limit of 45 days, but in reality this is done on the same day,” Yang said.LESSONS FOR INDIAOne of the biggest lessons for India is to go paperless. “The attempt is now to go completely paperless and depend on IT interface to process claims and check frauds at the same time,” said Kiran Anandampillai, who has helped in setting up Ayushman Bharat’s IT platform.South Korea’s NHIS has 3.4 trillion data points, which have been used for various purposes. With all Koreans covered with insurance scheme and entitled to periodic health checks, the data is now being used to give personalised health advice.The biggest use that South Korea has put the data to has been in filing lawsuits against tobacco companies. With specific data, NHIS was able to calculate quantum it was spending in treating diseases related to smoking.THE CHALLENGES AHEADSouth Korea’s universal healthcare system faces a challenge in its gatekeeping system. Unlike Ayushman Bharat, which is linked to Aadhar, South Korea’s system has no such checks. “There could be cases where a person can use another’s identity,” Yang said. “We can learn from India’s unique identification card.”(The correspondent was in Seoul at the invitation of Korea Foundation)
from Economic Times http://bit.ly/2x9fQzm
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