India’s Deficient Healthcare System: Is Public Healthcare the Only Model?
Must India model its healthcare system on the vastly inefficient and costly healthcare system of the West?
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he Euro-zone health system costs the tax-payer close to a trillion dollars (two-thirds of total healthcare expenditure paid by the State; total healthcare expenditure by EU is 10% of EU GDP, that is US$ 15 trillion). Ditto multiplied by two for the US. One trillion and two trillion for EU and US respectively.
As a result of high tobacco consumption, aging problem, China’s expenditure on healthcare is expected to be a trillion dollars by 2020, due to proposed expansion of facilities, coverage.
The combined population of the US and EU is about the 800 million – versus the 1200 million of India. Even if due to lower costs, India were to replicate the EU and US systems, the expenditure will be US$3 trillion. That is 50% more than the Indian GDP.
Simplistic?
Sure. But, if we are going to throw around billions and trillions that belong to taxpayers, why worry?
These systems will collapse – and when that happens, there will be plagues and epidemics across the West.
Remember that less than a 100 years ago, the flu-epidemic killed tens of millions in the West. Conservative estimates start at 2 crores, go to realistic estimates of 4 crores (40 million) and some estimates go beyond 5 crores (50 million). This depletion in population, coupled with WWI deaths toppled the West into the Great Depression, ten years later.
As John M. Barry, author of “The Great Influenza,” has observed, “Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in 24 weeks than AIDS has killed in 24 years.”
The State as the natural and logical answer to every social problem is uniquely modern extension of Desert Bloc model of governance. The confidence that media and academia project in this model has no relation to reality.
We have seen the collapse of Spain, Portugal as imperial powers, Britain is at a tipping point – and many expect Pax Americana to follow.
Why must India duplicate this vastly inefficient and costly healthcare system of the West, as this recent article in the FT suggests.
Western governments could haul New Delhi to the WTO dispute panel to challenge its patent law as non-compliant with global trade rules, generics executives’ and health activists’ bigger worry is that the EU, and eventually the US, will secure provisions in new free-trade deals. These provisions would give western drugmakers more tools to stop Indian generic rivals.
Western pharmaceutical companies counter that India’s real health crisis is not the price of a handful of patented drugs but of a government that has abdicated its responsibility to ensure decent healthcare for its citizens. India’s government spends less than 1.2 per cent of gross domestic product on healthcare.
Some western companies, led by GlaxoSmithKline, are trying tiered pricing strategies in India to reflect the extremes of its wealth and poverty. Merck Sharp and Dohme sells its patented diabetes drug Januvia in India for about $24 per month, 80 per cent lower than its global price.
Still, the cut-rate price for Januvia has not deterred Glenmark, an Indian generics firm, from making its own version, which it sells for 30 per cent less than the discounted price. Last month MSD tried unsuccessfully to get a court order stopping Glenmark from selling its medicine, and protracted litigation lies ahead.
“You can parachute free medicine across the country but that will not improve access because you don’t the health infrastructure,” says Mr Shahani. “You don’t have doctors, you don’t have nurses, you don’t have nursing homes and you don’t have diagnostics.”
Shortages of nurses and orderlies meant young doctors had to do menial tasks such as carrying laboratory samples or wheeling patients into the operating theatre.
The junior doctors say the public hospital is so overstretched – and poorly managed – that they have to make snap decisions on how to handle patients, as if processing the wounded from a battlefield.
“This government doesn’t want patients to die, so our major concern is to prevent death, but what about proper management after that?” asks Sameer Prabhakar, a doctor at Safdarjung. “A doctor seeing 100 patients a day won’t have time.”
Safdarjung’s problems resonate across India’s public health system, which is starved of funds. Clinics struggle to cope with the flow of patients who can spend days queueing to see a doctor, only to be told they will have to wait months for treatment – even for potentially fatal diseases such as cancer.
India has just six doctors and nine hospital beds for every 10,000 people, compared with 15 doctors and 38 beds in China, and 24 doctors and 30 beds in the US, according to UN data. “The biggest question is: why is the government not building more hospitals and opening more medical colleges?” says Dr Prabhakar.
The emergence of swish upmarket private hospitals catering to India’s rich and middle classes is exacerbating the strain on public hospitals, as doctors, nurses and other specialists are drawn to the higher salaries and better working conditions.
With India spending just 1.2 per cent of gross domestic product on health – compared with nearly 3 per cent in China – the problems will not be resolved easily. Many poor Indians go to unqualified quacks. Lower middle-class patients are driven to private hospitals they cannot afford, clocking up debt to pay for essential treatment.
Related Articles
- World economy in a tizzy, but Indian pharma flying high (thehindu.com)
- Should pharma MNCs be peeved? (rediff.com)
- India’s Solution To Drug Costs: Ignore Patents And Control Prices – Except For Home Grown Drugs (forbes.com)
- Fortis Healthcare to raise Rs 322 cr via IPP (news.in.msn.com)
US Medical: Workings of Private Hospitals and Individual Customers
Would all those in the fan club of Yummrika’s ‘systems’ like to take a look at the US medical system? .
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Around 20% of US residents do not have access to the US medical facilities on fair terms. This has been a long running racket in the US medical industry – and the US Government has made some ham-handed attempts at solving this problem. | Cartoon titled The Raft Of The Uninsured- By RJ Matson, The St. Louis Post Dispatch – 11/21/2006 12:00:00 AM
he US Government recently passed laws ‘compelling’ hospitals to ‘reveal’ prices that they charge for uninsured individual customers – who are also not covered by employer medical insurance, or State Medicare, Medicaid system.
Yumm-Rika – The Promised Land
We recently also covered some tweets from some more knowledgeable people on how the US is the most consumer friendly.
My observation: Governance in USA revolves around Citizen Safety and Citizen Convenience. Just love it!—
Vinita Deshmukh (@VinitaDeshmukh) April 25, 2013
But even in this backward country, India, private medical costs are easily and commonly available. And for those who can afford, there is vast network of private medical care. For those who cannot afford, there is the State-assisted medical hospital system, which provides, few questions asked medical services to any comer.
Cartels and Monopolies
One can quibble, one can cavil, one can whine and moan, but is there anything worse than a country-wide cartel of hospital systems that will not reveal heir costs to the consumers, upfront, openly and freely.
And this is the system that India trying to copy – and promote.
No wonder we have this new phenomenon that private insurers promise cashless medical insurance – and after the patient is admitted, after costs are approved, at the time of discharge, the hospital presents a bill to the patients, of costs that not approved by the insurer.

The Government bill, running into a reported 2700 pages has been challenged in the Supreme Court. The current administrations point of view is that some solution is better than the rampant abusive cartelization that is presently the norm | Cartoon titled Obamacare Bike By Pat Bagley, Salt Lake Tribune – 3/27/2012 12:00:00 AM
Maya ahoy!
On with the story. American media is breathless with astonishment, when it took all the might of the world’s sole super-power, the US Government, to publish medical information on a Government website.
WASHINGTON — The actual cost of hospital care became a lot clearer for consumers on Wednesday when the Obama administration released the average prices charged by more than 3,000 U.S. hospitals for the 100 most common medical procedures.
The 2011 data, which shows wide cost variations at hospitals across the country – and in the same city or geographic area – raise questions about how treatment prices are determined and why the information has been so hard to get in the past.
Rates paid by private insurers and public health plans like Medicare and Medicaid are typically much lower.
The cost information is being released for the first time with the intent to “save consumers money by arming them with better information that can help them make better choices,” said Health and Human Services Secretary Kathleen Sebelius.
“When consumers can easily compare the prices of goods and services, producers have strong incentives to keep those prices low,” Sebelius said.
Inpatient charges to treat heart failure in Denver hospitals, for instance, ranged from a low of $21,000 to a high cost of $46,000, while the same procedure ranged from $9,000 to $51,000 at hospitals in Jackson, Miss. Inpatient costs related to joint replacement ranged from $5,300 at a hospital in Ada, Okla., up to a high of $223,000 at a hospital in Monterey Park, Calif.
That kind of price disparity puzzled Jon Blum, director of the federal Centers for Medicaid and Medicare Services. He said the cost variations could possibly reflect the health status of the patient, whether a hospital charges more because it trains future doctors, and even whether a hospital has higher capital costs that are passed on to patients.
But Blum added: “Those reasons don’t seem very apparent to us.”He said the charges “don’t seem to make sense to us from a consumer standpoint. There’s no relationship that we see to charges and the quality of care that’s being provided.”
Even though more than 40 states require or encourage hospitals to make their charges and payment rates public, the hospital association supports federal price transparency legislation sponsored by Rep. Michael Burgess, R-Texas.
Burgess’ proposal would require state Medicaid plans to ensure that states would pass laws requiring hospitals to make their charges readily available to the public and to provide information about patients’ estimated out-of-pocket costs.
via Prices for hospital care vary widely, even within same city, data show | McClatchy.
And who are these uninsured, the uncovered. There is fairly narrow range that the total number of the uninsured and uncovered was between 48-52 million legal US citizens and 10-15 million US residents who have not be legalized. To this add the fact that this data pertains to years 2011-2012. Due the current economic climate this number probably is closer to 65 million US residents. That would be around 65 million US residents. In a population of some 330 million. 20% of the US population.

Not surprising that vested commercial interests who have been running an opaque medical system, are spending massive amounts of money in lobbying with their law-makers. This lobbing in USA, in India would be called bribes subvert a solution | Cartoon titled Obama Care By Arend Van Dam, source & courtesy – politicalcartoons.com on 3/26/2012 12:00:00 AM
And the Obama administration has passed a 2700-pages medical insurance law to cover these uninsured.
Three groups comprised the bulk of the uninsured in 2010, including foreign-born residents who are not U.S. citizens, young adults ages 19 to 25 and low-income families with an annual household income of less than $25,000.
The percentage of people who had health insurance through their employers fell to 55.3% in 2010 from 56.1% the year before, continuing a long, downward trend. In 2000, 64.1% of the population received health insurance through their employers.
The average health insurance premium for family coverage has more than doubled over the past decade to $13,770 a year, according to the Kaiser Family Foundation, a non-profit which focuses on health care policy and issues.
With fewer Americans receiving health care coverage through their employers, government-funded programs like Medicare, Medicaid, military health care, the Children’s Health Care Program (CHIPS) and coverage offered by various states have had to pick up the slack.
In 2010, 31% of Americans relied on the government for health insurance, up from 24.2% in 1999.
Many of the new government beneficiaries are children, according to Gould. Still, Census reported that 9.8% of children under age 18 are uninsured despite the government programs targeting them like CHIPS and Medicaid, which is also open to their parents.
Adults without dependent children, however, are not eligible for Medicaid in most states under federal rules, said Rachel Garfield, a senior researcher on the Kaiser Commission on Medicaid and the Uninsured. It’s this group that accounts for a large portion of the increase in the uninsured.
Nearly one-in-four working-age adults are uninsured, said Gould. She said it won’t be until 2014, when Obama’s Affordable Care Act fully kicks in, that more people will be able to find affordable health care coverage.
Kathleen Sebelius, the Secretary of Health and Human Services, said the report is evidence that the Obama administration’s health care reform is already starting to work.
Citing a provision that went into effect last year that allows parents to keep their children on their health insurance policy until they are 26 years old, Sebelius noted that the percentage of young adults ages 18 to 24 who were insured increased to 72.8% in 2010 from 70.7% in 2009.
Number of people without health insurance in U.S. climbs – Sep. 13, 2011.
After a year of bitter and partisan wrangling, the Obama administration passed a law that will enable coverage of these uninsured /uncovered.
If it survives Supreme Court scrutiny, the landmark overhaul will expand coverage to about 30 million uninsured people, according to government figures. But an estimated 26 million Americans will remain without coverage — a population that’s roughly the size of Texas and includes illegal immigrants and those who can’t afford to pay out-of-pocket for health insurance.
The US Government itself recognizes a figure that varies around 50 million. This excludes US residents who have been living in the US for several years – and there is an ongoing debate on how to legalize these residents.
The percentage of people without health insurance in 2011 decreased from 2010. In 2011, the percentage was 15.7%, compared to 16.3% in 2010. During 2011, an estimated 48.61 million people were without insurance, a statistically significant decrease of 1.34 million from the estimated 49.95 million uninsured in 2010. (via Overview of the Uninsured in the United States: A Summary of the 2012 Current Population Survey Report.
Related Articles
- Hospital Prices Vary Dramatically – ABC News (abcnews.go.com)
- High hospital bills go public, but will it help? (news.yahoo.com)
- New Report Shows Staggering Differences in the Cost of Medical Treatments (pbs.org)
- Hospital prices diverge wildly, U.S. data show (latimes.com)
- New hospital data shows giant swings in prices (vitals.nbcnews.com)
- Some hospitals charge vastly more for same care (cnsnews.com)






f people are becoming richer, more educated, in better living conditions, in a technologically superior time than any other in history, why can’t they afford children?


ajiv Malhotra, I have bad news for you!
hina has long wanted to 
very remarkable thing in India is

Exciting new series. From 1 Mar, 2010.