Fortaleciendo los Seguros Sociales de Salud en Naciones en Desarrollo. Necesidades de Gerenciamiento y Requerimientos de Networking en los Seguros Públicos en la India

DANIEL MACEIRA

New Delhi

Simposio; International Symposium on Global Governance and Health 2014; 2014

Improving health care systems through social insurance schemes constitutes a key strategy in many developing nations. Their design and implementation requires specific managerial skills, which need to be enhanced. The World Bank implemented a series of five workshops to facilitate network development among public officials working on Government Sponsored Health Insurance Schemes in India (GSHISs), addressing priority topics defined by participants. The paper shows the results of the evaluation of the initiative, systematizing the information collected through a multiple-choice questionnaire performed during the last Forum, evaluations along Forums, as well as analyzing the opinions received during in-depth interviews with twelve key representatives of GSHISs. The Consultation brings strong support to the experience, reporting high levels of perceived quality, relevance of the topics addressed and significant correlation between emerging issues (needs) and Forums´ agenda. About 47% of participants considers Forums´ quality as very high, and 88% positively evaluates the topics addressed. There is a consensus across schemes about the need to improve public-private partnerships, normative development and package definition. Nevertheless, particularities emerge based on GSHISs´ scale and type: State schemes´ representatives request criteria for providers´ selection, while central scheme officials focus on enhancing coverage and improve hospital networks. Defining steps towards covering ambulatory care, as well as improving normative are not as relevant in large insurance schemes as in smaller ones. Among stakeholders, participants identify community and its social leaders as principal actors in GSHISs´ initiatives, requiring tools for consensus building, social leaders´ participation as mechanisms to improve accountability, and standardized criteria to identify patients´ perceived wellbeing.