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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?

US Healthcare costs and expenditure  | Credits and source details embedded in image.

US Healthcare costs and expenditure | Credits and source details embedded in image.

T

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.”

via Grounding a Pandemic – New York Times.

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.

via India: Patents and precedents – FT.com.


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  1. May 19, 2013 at 6:26 pm

    The biggest problem India face, is its propriety, allegiance and sense of sovereign duty. India is not ‘a’ country but a conglomeration of ill defined several countries imposed by the policy makers after 1947. It is here I keep raising voice for forcing Ms Sonia Gandhi to release the secret correspondence between the two unidentified Platonic lovers to exactly judge the impact on the post-independence political policy formulation. Once someone asked on the net that what will be the use of it now? Good question, sometimes we have to exhume a deadbody also because it serves some purpose. Same way a postmortem is helpful. Take this as postmortem to dig certain clues which ultimately may/will prove useful for our current policies or some other reasons which may not possible to judge right now, like any other CBI investigations. One only knows it later but its value cannot be underestimated.

    Coming to the health problem, I had writen a long letter to PM Bajpai while he was holidaying in Kerala, way back. The letter was never acknoledged, till date despite the fact that it sent under Regd/AD post.

    As you rightly raise this issue, India instead of sulking on its poor resources, should relearn to learn to manage its house within its resources. This brings me to the relevance of my opening lament of the Platonic dirty business and its impact. Nehru became more busy in his own showmanship than being encoumbered with the National issues. Those letters will be or may throw the dynasty off gear to liberate it from the draconian clutches of this corrupt insensitive dynasty.

    India needs a rethinking on its fresh health model that will suit its people, its resources (limited) and accordingly develop its health system. I propose a five tiered health planning from the rural to the Metros. The whole thing again revolves round willingness, true feeling for the masses than mere vote bank rhetorics wasting huge money in fake seasonal election time schemes. This idiot Raul Vinci aka Rahul Gandi is useless and if we are embroiled into this white skin legacy of Macaulayism, don’t expect much to be delivered.

    Start with the most primary health centres based at the most interior villages, manned with, may be only a trained senior Nursing staff (male and females togetther to cater for the basic day to day ailments under the close liason of trained medical officers based close by at secondary and tertiary centres, where there will be hospital beds and other specialist facilities for extended services. Secondary centres should be manned with the olden British time LMF, LMP style doctors, who will cost much less to produce and will be an insurance to stay put in those centres. They will not run away for reasons should be understood. If they fail, the patients can be immediately shifted at the tertiary hospitals based at Subdivisional and District levels with all facilities. This will require not only Medical facilities but also development of infrastructure facilities of power supply, road and other communication network including uniterrupted telephonic services for transportation and fast consultations.

    At fourth tier lever, build Medical Colleges which should be tagged with the particular area hospitals, which can then finally refer the cases for tertiary specialist care with all facilities. Medical Colleges will have a fully developped academic units, including post graduate teaching and academic activities. A Medical College should be earmarked for an area with its responsibility of full supervision.

    Lastly but not the least, at fifth tier level, there should be academic Institutions of All India Institutes of Medical Services like Delhi, Chandigarh and several other places in the country which will again liase with their earmarked Medical Colleges whom they will cater for and these Medical Colleges will also refer all the difficult cases those couldn’t be tackled locally. These 5th tier Institutions should not be permited to average routine problem patients, who should first get into other nearby hospitals or other medical facilities. Urban centres can be accordingly mapped out and the facilities developped as per the need.

    I don’t think that an MBBS graduate who costs no less than about fifty lacs rupees and a long career for training should be wasted at a non feasible facility with no infrastructure and where his requirement is nil. The leaders feel ashamed in front of these rapacious western politicians for being “inferior to them” psychology. It is here that all considerations like corruption, Nehruvism, need based fresh thinking to develop a suitable model for rendering health services to the masses is needed. I am sure, if India works out such a suitable model, they can even sale it to other developping and underdevelopped countries and make money out of its expertise. Americans made a huge business out of such services and created job opportunities in Middle East countries. I had an occasion to travel to a few countries and worked to see it.

    The Indian politician has to relearn to learn to manage its country as one would his own house. The politician-bureaucrat nexus need to be dismantled. Otherwise people like you, me and other like minded will keep writing posts, while Delhi Babus and Mems will siphon out the money to Swiss Banks and wherever it suits them. Sloganising of “poor paople” is a buzz word we often keep hearing from these debauch shameless netas will keep resounding but for nothing. Sonia has no shame to travel secretely to US under all silly privacy for treatment, while the locals keep dying even in absence of basic needs. This country needs a huge overhaul before it can be put on the rudder.

  2. Manu
    July 10, 2013 at 12:38 am

    Here is reality from the ground in
    Australia . I am lucky I am Indian as I can get cheap good and prompt service every-time I go home. Even with premium health insurance the wait to see a specialist is between 1-2 months. An ambulance call can set you back by 5000 dollars so you need to take out separate insurance for that. A friend was put in hospital and loads of tests performed on her to diagnose the problem with nothing coming out of it. A visit to India and all she had was vitamin B12 deficiency

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