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WELCOME. By Prof.S.Chakraborty Director Jaipuria Institute of Management Lucknow, INDIA. GOAL OF DEVELOPMENT. Social justice something that goes beyond Economic Growth. Development happens through. Income security Securities against contingencies Environmental security. From

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Jaipuria Institute of Management

Lucknow, INDIA.


Social justice

something that goes beyond

Economic Growth

Development happens through

  • Income security

  • Securities against contingencies

  • Environmental security


Having people on rolls

Job growth in the organized sector


Buying service from people.

Job growth in the unorganized sector

Shifts in Employment patterns


  • Lack of clear cut employer – employee relationship

  • Increasing income insecurity

  • Vulnerability of the workers

Social Security, social integration and health

  • Mortality, morbidity and life expectancy – all directly influenced by standards of living.

  • Strong association between income inequality and excess mortality.

  • Two – way casual relationship between health and wealth.

Need of the hour

Social protection

Eradication of problems not just prevention of a decline

Sophisticated forms of targeting and monitoring

Innovations in the social sector.

Health care delivery scene in India

  • Faced with the dual challenge of ‘diseases of poverty’ and ‘diseases of prosperity’

  • Real vs articulated demand

  • Public spending ratio is 1:3 between the poorest 20% and the richest 20%

Estimates of household expenditures/treatment costs per episode/per year in India

Key challenges

  • Creating efficiently targeted policies with widespread public participation

  • Integration of social and economic policies

  • Keeping the cost of administration low

  • ‘Prevention’ against increases in deprivation

  • ‘Promotion’ of better chances of individual development

  • Intensifying focus towards ‘needy’ (contribution or no contribution)

  • Shifting away from large scale universal systems

Need of a focus shift in social security

in order to

  • enhance and protect peoples’ capabilities

  • provide benefits through public or collective arrangements

  • help people to cope with various insecurity dimensions

    -poverty levels

    -casualization of employment

    -gender inequality

  • improve opportunities and choices before individuals.


Poverty is not just a state of deprivation.

It is equally a state of vulnerability

Market – oriented interventions in the health sector

Does the assumption of ‘perfect market’ work?

Perhaps can work only when – those with greatest need are also those with most resources

Key assumptions in market functioning

  • Perfect information

  • Free entry and exit

  • Fair distribution of income with all having an ability to pay

Scenario in Health Sector

Wide range of market failures because of

  • high element of risk and uncertainty

  • moral hazard

  • adverse selection

  • externalities

  • assymetrical distribution of income

The big question

Does the market – oriented health – care systems actually work?

Health care through social security schemes

Displayed characteristics

  • Have an urban orientation

  • Caters to those in the organized sector

Employees covered under different system (number in millions)

Low – income organized sector workers

  • For these workers there is a mandatory, contributory scheme known as Employee State Insurance Scheme (ESIS) run by Employee State Insurance Corporation (ESIC)

  • As on March 31, 2006, ESIC covered around 8.5 million insured persons/family units

Notable features of ESIS

  • Workers with a salary of less than Rs.10000 per month can join

  • Workers earning less than Rs.50 a day (approximately $ 1) are exempt from contributing

Typology of Risk Pooling Schemes in India Today

Quality of Service

Some common complaints are

  • long queues

  • non – availability of good quality medicines

  • problems with reimbursement

  • non – availability of service in certain geographical regions

Health security

  • Requires to ensure low exposure to risk

  • Provides access to healthcare services along with ability to pay

Burden of treatment


Cost of treatment + loss of income


Little attention has been paid to the burden factor

Does health insurance answers the need?

  • Perhaps yes, for those who can afford to pay when they are healthy

  • Apparently no, when it comes to the poorer section

Social security needs in developing countries

  • To ensure that members of the society meet their basic needs as well as remain protected from contingencies.

  • To enable members maintain a standard of living consistent with social norms.

What does it call for?

Greater emphasis on social justice and social rehabilitation

not limited to

only medical rehabilitation.

Envisaged needs

  • Innovations in social sectors to make life better for our millions

  • Focus on indigenous development with local expertise on local problems with local content of local relevance

  • To create economic and social developments from below

Recent Developments

  • Universal health insurance scheme of Govt. of India (focussed on BPL section)

  • Yeshasvani Co-operative health care scheme in Karnataka (mainly focussed on farmers)

  • Innovations in Arvind eye care centre, Madurai, Tamil Nadu (brought down the cost of cataract operations)

  • Kudumbashree programme in Kerala (state poverty eradication mission)

  • Grassroots innovation augmentation programme (GIAN)

  • ………… and many more

Efforts of late …….

are in the right direction

India is on the move showing signs that

  • People have learnt to escape from old ideas

  • Serious note has been taken of what Amartya Sen had said, “Development without participation is a sin.”

As a consequence

‘I’ in India has started changing

It is no longer

  • Immitation and inhibition

    Instead it is

  • Innovation and Creation of value from ideas

Thank You

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