Killing healthcare

On June 21 this year, 35,000 unsuspecting Indians lined up at the Rajpath in a sea of yogic chorus, with great expectations of a healthy life. But we need more than hyperbole on yoga to make healthcare meaningful. Little did those who assembled there know that the government had slashed off 20% (more than Rs 5,000 crore) from the annual health budget.
Reduction in healthcare funding, when we have a lot of catching up to do both in primary and specialty healthcare? Unbelievable and cynical, but that is exactly what has happened.
If we delve deep into history to find another example of a growing economy slashing its commitment to healthcare, we wouldn’t find any. Not even Greece. The dismantling of any aspirations of welfare has begun. Over the last three decades, we were perhaps the only country whose increment of health expenditure consistently lagged behind the rate of growth of the economy. A pitiful 2% GDP is spent on health.
National healthcare expenditure ranges from 20% in the US, 15% in the UK, to around 10% in Bangladesh and Iraq.
Indians spend nearly $200 billion per year on healthcare, 70% of which comes out the not-too-deep pockets of the “aam aadmi”.
Healthcare turnover increases at 12%-15% per year, which is all from out-of-pocket payments. Every third hospital bill causes catastrophic debt. A scarce product that we all desire but very few are able to reach. It is a glass of water in the midst of a desert, but it comes at a steep price. Is this the most considerate allocation of a nation’s financial resources?
Defence allocation goes on increasing, regardless of the condition of the economy. It’s in direct contrast with health spending, which has trailed far behind the economic growth rate. Protecting a nation of ill educated, sick citizens with fancy missiles and nukes! Did the slashing of the health budget create a ripple of concern? Only in select (and concerned) circles.
At the mere mention of Pakistan-phobia, even the most ridiculous arms acquisitions would go through. As the MPs feast on subsidised biriyani, nutrition, vaccination and care of mother and child can wait.
The indifference to health is historical. The historical apathy trails from Nehru to Modi. The reality is, human life is a disposable commodity in independent India.
The state conducts DNA tests on dead bodies. They may not have had a haemoglobin check in their lifetime. Very syndromic of a social order that values Sensex over the human development index.
If 2G, Vyapam, Lalit Modi and Coalgate scams are added together, all Indians would have their healthcare paid for in the next two decades.
But alas, the proverbial common man is a “use-and-throw” entity — or, rather more aptly in the Indian perspective, ‘Vote and Die’. The case of the ‘disposable citizen’, in other words.
Has the country come to terms with the fact that the majority of the capacity and responsibility would lie with the private sector? If the state is reluctant to fund healthcare expansion, will it facilitate the private sector to do so?
Populist governments have thrust low-paying schemes down the gullet of private hospitals, rates at which even government hospitals would struggle to manage.
In the southern states, one is hardly surprised to see a family arriving in a imported sedan flashing a BPL health card. This has made a mockery of the break-even revenues and high infrastructural costs for the private sector.
Corporate health insurance is a loss-making proposition for all insurance firms. Viable health insurance has not even penetrated to 10% of the urban population. Not surprisingly, investors are rather reluctant to step into healthcare. Hence, capacity expansion is at an all-time low. We have less than half the capacity necessary. It is increasing at a snail’s pace. Medical tourism has helped sustain the industry, but that does not solve the problem at home.
Flirtations with “low-cost healthcare” are well and truly over. Dispensing philanthropy with high cost of capital is simply not sustainable.
A viable economic model rather than opportunistic populism would revive a struggling industry.
Without exception, professional healthcare organizations have been tamed into political obedience. Monitoring the rationale and adequacy of healthcare infrastructure is well beyond the perspective and of self-seeking associations. Nero sings as Rome burns. The tragedy has been patronized by the indifference of the intelligentsia. The content of electoral debate in the US and UK is dominated by healthcare. Perhaps that will happen some day in India, too.
Fiscal apathy is callous. Euthanasia is not the remedy that healthcare is looking for.
— The writer is a well-known cardiac surgeon, who’s the senior vice-chairman of Medica Superspecialty Hospital, Kolkata. The views expressed here are his own.