Millennium Post

The steep cost of healthcare

When the wife of the chief executive of India’s biggest public sector health insurance company recently visited a private medical specialist to cure her sudden and severe headache, she had no clue about the procedure she was about to go through at the clinic and the aftermath of that procedure. The dutiful doctor, knowing her background fully well, refused to take any chance. She was made to undergo a whole lot of tests, including a MRI, for the next two days before she felt the headache was gone. But, that was to be only a temporary relief. The final medical bill of Rs. 20,000 that she received after the thorough check up was threatening to cause her another headache.

Employees of a good number of public sector undertakings are entitled to reimbursements of medical expenses for self and the spouse until death. This has opened a new opportunity for private healthcare providers in India though the total market of such cases is still very small. In most other cases, medical bills are picked up by patients or their guardians. And, that is becoming the biggest headache of the country’s poor as well as the self-supported middle class.

The healthcare industry is not regulated. No patient knows the real cost of treatment or implants. Even private hospitals and clinics may not. Or, maybe, they don’t care. Although some drug prices are regulated, they are of little use to patients visiting private doctors and clinics in distress that habitually prescribe more expensive branded drugs and their combinations. Ailing patients and those who care for them have little clue about what the cheapest and most effective version of the drug they so direly require is.

The test and treatment regime drives a good number of them penniless and forces them to sell their small assets to save their quality of life. Official estimates say nearly 40 million low-income category people enter the below poverty line (BPL) group every year in India financially wounded by the burden of medical expenses. The commitment of the ‘health-for-all’ by the UPA government remained a white lie and seemed to have ended with that government. The new NDA government and its health ministry don’t seem to be in a hurry to undertake any such grandiose programme. The budget for 2015-16 practically makes no real extra provision on public healthcare.

The public spending on healthcare for India is only 1.04 per cent of its GDP, making it among the lowest in the world, says New India Assurance Chairman G. Srinivasan. The average global government spending in healthcare is 5.4 per cent of GDP. Nearly 80 per cent of the gross healthcare cost in India is borne by the public themselves. The rest are covered by the government and insurance business. Ironically, the reverse is true in developed countries. In most cases, insurance covers only a fraction of India’s healthcare costs. For instance, the most common cataract surgery bill in India can vary from Rs. 20,000 to well over Rs. 1,00,000 for a single operation depending upon the clinic’s status and the lens implanted.

Charitable cataract operation of the poor has often been causing mass blindness for several reasons. No doctor or charitable institution’s management are known to have been sent to jail for such egregious medical negligence. A busy city eye surgeon often conducts 40 to 50 operations per day. Not all patients regain ‘good’ vision after operation and implant. The indiscriminate operations for making quick buck by clinics and doctors have placed India as one of the world’s top centres of child delivery through caesarian section. Surgical intervention for child delivery is certainly not the order of the day in advanced countries.

The annual growth of India’s healthcare is high: around 15 per cent. According to ICAI president Dr. A S Durga Prasad, the sector grew from $45 billion in 2008 to $78.6 billion in 2012 and it is expected to touch $158.2 billion by 2017 as the country’s per capita healthcare expenditure is shooting up. Unlike in advanced countries, the real healthcare costs have remained an enigma for all concerned stakeholders. Lack of transparency in pricing, standardization in facets of healthcare pricing and lack of standard clinical protocols are among the factors standing in the way of effective healthcare management that benefits all. The insurers, government, insured, healthcare institutions and cost managers need to take a visionary view of the subject that will make quality healthcare affordable to the country’s population. Without deep insurance penetration, India can’t expect better and affordable healthcare management, which is currently driven by generally vague clinical and surgical protocols, excessive hospitalization, investigation, surgical, medicine and implant costs and a near absence of effective regulations.

Almost all are unhappy with the way the healthcare management has taken root in the country with lack of bed density (50 per cent of the global average), poor doctors’ availability (one in 1,700 people), poor conditions of affordable dispensaries, clinics and hospitals, poor sanitation and drinking water, falling real public healthcare expenditure and rising; and often unreliable, private healthcare costs. Yet, there is no national movement towards right to good quality affordable health care for the people.

People, rich or poor, are dying in hoards to all kinds of diseases – from the latest spate of swine flu to hepatitis, cholera, intestinal diseases, diabetes, cancer, traditional failures of heart, lung, kidney and lever among others. Unfortunately, this does not seem to shake up the society and Neta or Netri in the central and state governments. While India is a major drug exporter to the world-worth over $14 billion in 2013-14-its own citizens are dying for want of affordable drugs, reliable and affordable doctors, hospitals, clinics and test labs.

The saddest part is that despite India being a $3.1-billion medical devices market, little safety record of these instruments exists. Babies are burnt due to short circuits in incubators. Hip transplants often end up in blood poisoning. Although the health ministry has approved a material vigilance programme to ensure safety of medical devices, the issues don’t move the society as a whole. The healthcare trend in India continues to be sadly shocking. IPA

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