Thursday, July 2, 2015

India has given up on its citizens' healthcare

We were sitting in an executive room of one of the big private hospitals in the country. After our point of meeting was discussed, the two senior healthcare professionals lamented on the severe shortage of healthcare amenities in the country. 

Contrary to my expectation, they both rued the fact that unlike other countries, Indian government was not spending enough money on setting up public hospitals and healthcare facilities. They said that private hospitals such as theirs will never be able to serve the majority of India's population because of the costs. A larger public healthcare system will also ease their own pressures and workload. Also, hospitals need to be in the vicinity of people rather than far away. In their experience, they find that people prefer a 'good-enough' doctor closer to home than the 'best' doctor far away. Some of the government hospitals they had seen had an extremely good infrastructure and simply needed to be managed well. 

I got curious about our spending on healthcare and some basic research paints a very dismal picture. India has one of the lowest spending on health in the world. It is a miserly 4.5% of our GDP. Rather than GDP, the share of government's expenditure will paint an accurate picture about the government's intent towards providing minimum healthcare to all its citizens. 
And that's where we fall spectacularly. Only 4.7% of our annual budget! All the countries listed below including Pakistan (4.8%), Bangladesh (7.8%) and Nepal spend more share on their citizens' health. USA, UK, Germany, Japan spend close to 20% of their expenditure on health. China is getting there slowly.

Health Expenditure by the Government
All data from WHO (2013)

If one believes that healthcare is a public good and quality healthcare should be provided to all citizens, then a larger share of expenditure needs to be borne by public funds. Higher spending in private institutions in health (like in education or transport) indicates an unequal society. This also reflected in the data. 

More equal societies like Scandinavian countries, Germany, France, Japan etc showed more than 70% of healthcare expenses borne by the government. Unequal societies like USA and China had more private spending. Sadly, we had one of the lowest public spending in the world at 32% with the remaining 68% being paid by citizens to private institutions. 

Public vs Private Distribution of Healthcare Expenditure

The lack of public commitment to health simply creates a market for private players to provide services and extract profits. Our politicians have their hands deep inside this market. Given the fundamental nature of health, it is the poor that are affected the most.

Additionally, we have a severe shortage of skilled human resources in this field. The Medical Council of India is one of the biggest scams in the country which doesn't allow setting up of more medical colleges despite dire need of professionals. The crores of backdoor donation industry keeps on thriving while the Indian government has given up on our healthcare.  

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