Universal healthcare for India

| | in Oped

Indians are reputed to be one of the world’s best healthcare providers and yet, within India, the healthcare system is abysmal. To improve the situation, the Government must harness the strength of the robust private sector

With a population of more than 125 crore, contemporary India yearns for another opportunity to become a global leader. Given our credentials of democracy, diversity and tolerance, many look upon us as the future of the world. But rural-urban divide and a non-inclusive, lop-sided development model remains a matter of concern.

While Silicon Valley in the US thrives upon the innovative minds of Indians, India has no credible research and development programmes or innovations to boast about. Indians constitute five per cent of the total doctors in the US (and 20 per cent of its international medical graduates). Indian health workers are also the pillars of medical services in Middle East. Yet, India is struggling with health challenges.

With a massive population load and per capita gross national income of $3,900, India spends just 4.1 per cent of its national budget on health. It has one doctor for ever 1,700 citizens (according to the World Health Organisation, the optimal ratio should be 1:1000).

Cuba has 6.7 and America 1.5 doctors for every 1000 persons. With a per capita gross national income of $54,000, the US spends about 18 per cent of its budget on health. This is not to say that everything is in perfect shape in the US. Many feel that the American healthcare system is broken due to its inability to provide healthcare to millions of un-insured people.

The most prevalent service model is paying out of your pocket. The patient is responsible for footing the fee and bills for the doctor and the hospital. In India, many will point out, that the Government does provide free universal health care to all its citizens. That is true. Anyone can visit a Government healthcare facility and avail treatment almost free of cost. But the Government facilities are dilapidated, over-crowded and dysfunctional, thanks to poor work ethics, chronic absenteeism and corruption.

Contrast this to Britain’s National Health System, called the Beveridge Model. Here, the Government provides healthcare through its own system of doctors, clinics and hospitals. The private medical sector is negligible. Everyone is eligible to choose a general practitioner, who is the primary doctor, and can avail medical care free of cost (the care is free at the point of use). The Government pays the bills.

In communist Cuba, hailed by many as a successful model for the developing world, the same system is seen in extreme form: The whole health care system — be it clinics or pharmacies — is owned by the Government. No doctor can have a private practice.

Canada also provides a universal healthcare to its citizens but in a different way. The Government provides every citizen a health insurance. The patient can choose to go to a private clinic or a Government doctor or facility.

Germany has a slightly different system. The Government mandates a health insurance for everyone, and that is provided by the employer. The employee also contributes to a that insurance. But the system is created not-for-profit and covers everyone, even if unemployed.

The above models are typical examples of what is  called ‘socialised medicine’, where the Government pitches in to provide subsidies through taxation. In other words, these are public-funded healthcare programmes.

In the US, the concept of universal healthcare is fuzzy. According to the Institute of Medicine, the US is an exception among the developed countries as it does not provide a universal healthcare. The Government hardly runs any healthcare centers (except a few county hospitals, administered by county Governments, such  the famous Cook County hospital in Chicago).

For majority of the people, healthcare benefits come through their jobs. In other words, the employer buys the employee a private health insurance. The employee also pays a portion of that premium per month.

India has a mixed system where the Government pledges to provide healthcare but is unable to meet the demands. The private healthcare sector is robust but the poor and the needy may not be able to avail its services for want of money. So, how do we strengthen the healthcare system in India?

India needs to increase its Budget share on health, particularly preventive and primary healthcare. In addition, it must produce more doctors and para-medical forces. Instead of running the health facilities itself, the government will do well to broaden health insurance to its citizens and put good regulations in place so that, through the private sector, it can provide much needed healthcare to its citizens.

(The writer practises neo-natal medicine in Chicago)

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