Spending most of December in hospital, fighting a life-threatening disorder like GBS and shedding 11 litres of one’s precious plasma, does tend to focus one’s mind on the necessities of life we so often take for granted – like health care. With 16 days in a private room in a private hospital (including 3 awful nights in intensive care) I was presented with a bill which was over 31 times the average monthly income in India in 2015. Lucky me – I recovered 77% of this from my (private) insurer, but the balance was still a bit of a pinch. But life and health being too precious to put a monetary value on… blah… blah…
So what happens to an average Indian when faced with a health crisis like this? Good question.
Healthcare in India is literally on the horns of a dilemma: with 80% of the health infrastructure in the private sector, the medical insurance coverage is a mere 5%, limited almost entirely to the urban, educated, middle classes in India’s larger cities. So where shall the twain meet? In the last few years, the Government has made it binding upon private hospitals to reserve a certain number of berths for low-income patients, whose treatment will be free and is often subsidized by government. Moreover, subscribers to group insurance schemes like Central Government employees can now be treated at the best private hospitals, unlike before, when they could only go to government-owned facilities.
But this coverage is still extremely inadequate, and likely to remain so, as India still spends only around 4% of its national GDP on healthcare. With the growth of medical ‘tourism’ and the proliferation of large specialty hospitals in the metros, the gap between rural and urban healthcare increases day by day, and this deprivation in rural areas is very debilitating for India, as two-thirds of its population still lives in rural areas. Moreover, even in urban areas with the best medical facilities, the high out-of-pocket expenditure can cause severe hardship especially among the working classes, where an illness within the family can impoverish an entire household, and send it crashing below the poverty line.
The public sector is handicapped by poor infrastructure in rural areas, unwillingness of trained medical staff to serve in villages, absence of standardized diagnostic procedures and information systems, and an underdeveloped medical devices sector. There are various panaceas on offer, depending on your ideological stance: the free market enthusiasts see immense opportunities for the private sector in healthcare in everything from insurance, to pharmaceuticals to diagnostics. Those with a more pro-poor bias call for much greater government investment and regulation, so that private insurance companies do not set the agenda for India’s healthcare, as they already do in the USA.
I personally believe that the Nehruvian mix of a public sector conscience and private sector expertise may be the honourable middle road towards a more just and equitable healthcare system in India – and out of its present quagmire. A happier and healthier 2016 everyone!