Eternally neglected health system

Eternally neglected health system

There is lot of buzz around the NCERT’s (National Council Of Educational Research And Training) chapter for Class VII students. The purpose of this article is to provide a glimpse into the reality and let the readers to deduce appropriately. As per the Survey of National Sample Survey Office (NSSO, 71st round), 72 per cent of rural and 79 per cent of urban people visited the doctor at private clinic or hospital in the last year.

Let us analyse NSSO’s expenditure incurred by a family to deliver a child. In private hospitals, it is 9 to 10 times higher compared to respective public hospital. The costs for treating any ailment is higher at private hospitals with range varying from 3.2 times higher for cancers to 7.5 times for eye problems. While several questions need cognisance and contemplation, I limit myself to three questions for brevity.  Why costs in private a facility so high? Do high cost in private conveys high quality? Why does one have to pay in public health facilities? 

First, conjecture is to make people pay extra for services such as air conditioning, better customer service and prompt attending. The doctors may also be paid higher albeit it’s not same for supporting staff. After accounting for revenue, costs can only go uphill. Second, high cost in private sector is NOT synonymous with high quality. 

India is proud of many public hospitals providing high quality service at low cost. Some private hospitals hire untrained and unqualified support staff. Excellence is wishful with rise in hospital-acquired infections and for want of strict enforcements in quality standards. Third, it is deplorable that poor people continue to pay despite of government spending millions to incentivise delivery at public health facilities.

Undoubtedly, private healthcare industry is too big to be ignored or to be generalised as the only wrongdoer as done in NCERT textbook. Over last two decades, there has been steady increase in use of private hospitals for inpatients with analogous decline in the use of government health facilities. Sufficient data is unavailable to know whether part of this increase is also due to amplified and often unnecessary medical utilisation due to increasing insurance coverage (moral hazard). Instead, the government should look at flexible models of integrating the private health care system for efficient provision of health services. 

How to cut costs? Use of empirical protocols and strict implementation of quality should aid in fair price regulation. If regulatory agencies manage telecommunications and other services, why not the cost of surgery and procedures too be regulated by autonomous agencies? Once this is done, it is also important to regulate the moral hazard by setting up administrative mechanisms.  With the same order, public health systems should be strengthened to make them competitive.  

Investment in healthBarring one, none of the other state governments or the Union government has increased investment in health. At every opportunity, there have been attempts to decrease allocation to health. As a result, out of pocket expenditure is very high often impoverishing masses. 

In the last year alone, nearly two out of three families had to shell out household savings to meet medical expenditure. Nearly 26 per cent borrowed while 1 per cent sold their physical assets in order to pay for the medical bills. In simplistic terms, if the costs are not cut, there is no way future impoverishments can be reduced.  

Paradoxically, while US President Barack Obama cites Bengaluru’s Jayadeva Hospital as a perfect model to emulate, we are busy aping the US model of increased medical costs, increased co-payments and higher insurance premiums. The ecosystem neither empowers to cut costs nor does it incentivise to regulate. 

The NCERT chapter is inaptly titled as “Role of the Government in Health”. The disarray in health services is mainly a result of apathy at best by the governments in recent times. Once there is a political will to address real problems, meaningful roles will emerge and those would be better lessons to younger minds. It is not enough to articulate ills of the private hospitals to young readers without also offering hope that the systems can be changed for better. 

Our gift to children should not be fragmented, inequitable and lopsided health system similar to the one-sided narration of textbooks. It’s not the textbooks but the governments which can inspire future generations by correcting the current disequilibrium in health system. 

(The writer is Additional Professor at Public Health Foundation of India, Bengaluru)

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