JOIN USIt would be perilous for society to leave healthcare - and two other sectors, education and food - to the total mercy of market forces. The startling symptoms of the healthcare sector's commercialisation are clearly discernible; 63 children died in Gorakhpur (UP) over three days in August 2017 due to an interruption in oxygen supply, and a similar ghastly incident took another 14 lives of innocent children a month later at Farukkabad.
Look at some of the other most disturbing acts of misfeasance, malfeasance and nonfeasance committed with great impunity by those in the healthcare sector:
• Unscrupulous hospitals accept patients not based on the severity of disease and urgency of treatment, but on their paying capacity; those with disease but no money are sent away while those with sufficient money but no serious disease get unnecessary treatment.
• Doctors prescribe a battery of tests, codenamed "sink tests'', with one or two 'marked tests'. Patients are charged for all the tests and samples collected for all of them. But the actual test is conducted for the 'marked test' and fake normal results are given for all the other tests; the extra samples, say blood, collected is thrown in the sink, so the name 'sink' tests.
• Patients are unnecessarily referred to other doctors, just to get a cut from them.
• Illegal sex determination tests are conducted and the information is secretly conveyed, in code. For instance, a male child is announced as 'Ganesh' and female child as 'Lakshmi'
• Surgeries like hysterectomies, c-sections, cataract, knee replacements, lower back operations are unnecessarily performed.
• Pharmaceutical companies give expensive gifts and medical equipment to entice doctors to prescribe their drugs. Companies even sponsor foreign trips and five-star accommodations for doctors and their families.
• Poor and illiterate people are used as guinea pigs in clinical trials.
• Private hospitals bribe ambulance services to bring them emergency patients.
• Hospitals force doctors to generate a monthly target revenue to justify their high salaries.
The Medical Council of India prohibits all these unethical practices but that has had little impact on errant doctors and hospitals. The National Health Policy 2017, too, commits itself, "to the highest professional standards, integrity and ethics." Undoubtedly, that sacred goal is not achievable without halting the mindless commercialisation of the healthcare sector.
For the past 25 years, private interests have been getting precedence over the need to provide universal healthcare, forcing people to increasingly depend on the private sector.
Ground reality
As per the National Sample Survey-71, a high 72% of rural and 79% of urban spells of ailment are treated in the private sector. Private institutions dominated in in-patient treatment, both in rural (58%) and urban (68%) areas. Despite governments boasting of several health schemes, a high 86% of the rural population and 82% of the urban population are not covered under any such scheme. Another disturbing finding is that 20% of childbirths in rural areas and 11% in urban areas are still taking place at home.
The nexus between corporate hospitals, pharma companies and doctors has increased the risks and costs of healthcare to such an extent that millions of middle-class Indians descend into poverty; every year, more than 3.5 crore people fall below the poverty line due to illness.
The current health expenditure (CHE) (including prepayments for insurance premiums) by households as estimated by National Health Accounts 2013-14, was Rs 3,06,938 crore, equal to 2.7% of GDP, and 72.9% of CHE or 67.7% of total health expenditure. Of this, the out-of-pocket spending was Rs 2,90,932 crore, 2.6% of GDP or Rs 2,336 per capita.
However, the private medical industry has been flourishing, particularly after 1990. There are 10.4 lakh healthcare enterprises in the country, counting all from the very small to the very big. The size of the business, in 2017, was equal to $160 billion and is poised to grow to $280 billion by 2020. The Foreign Direct Investment the healthcare sector received between 2000 and 2017 was $4.34 billion. The number of medical tourists in 2016 was 2,00,000 against 1,30,000 a year before.
The government has the capacity to overtake the private industry, if it has the will. The High-Level Expert Group on Universal Health Coverage, set up under the chairmanship of Dr K Srinath Reddy (2011), has recommended that "the government should increase public expenditure on health to at least 2.5% by the end of the 12th plan, and to at least 3% of GDP by 2022. The current level is 1.15 of GDP (0.40% by the Centre plus 0.75% by states) against the global average of 5.99%.
In other words, the healthcare expenditure should come from the government, and the government should raise the money by taxing the rich, placing heavier burdens on broader shoulders. That means, radical changes are an urgent necessity; no symptomatic tinkering with the healthcare sector will work.
The present style of development, the rapid growth of the private sector may secure higher profits to investors but it does not bring better healthcare to individuals; no 'trickle down' benefits, so to say. On the contrary, there is every possibility of further increase – both in type and quantum- in unethical medical practices.
So, the right kind of treatment for the afflicted healthcare sector would be to delink it from the influence of market forces and to ensure hassle-free universal health coverage without intermediation by any insurance business. The government should realise that nothing can be more important to the nation than the health of its people and should act at once to correct course. Will it?