Talking heads

Hariom, a marginal farmer from Dausa District Rajasthan, had to shell out Rs 2 lakhs for the stents in the heart. The drug-coated stents are not part of the government supply at the Jaipur Medical College hospital. But, to save his life, the only source of livelihood, his farmland, had to be mortgaged. His family fell on bad times, in financial ruin. Hariom is not alone.

According to the World Health Organization, India’s out of pocket expenses on healthcare stands at 73 per cent, which is among the world’s highest. And that explains why healthcare remains the single largest cause of indebtedness in our society.

Universal health care was one of the tallest   promises UPA-2 made three years ago. That promise still remains unkept. The government was to set up a National Heath Mission by merging both the rural and urban health missions as declared by Prime Minister Manmohan Singh in August this year. There is no sign of it taking the final shape.

The fact is that public health reforms are way below on government’s priority list. It’s a subject routinely mentioned in election manifestos and routinely forgotten after the polls. In other words, politicians are not accountable when it comes to people’s healthcare.

This is in sharp contrast to the US experience. The American citizen’s health is the responsibility of the government. It is not merely an election slogan, but an election issue that can make or break a presidential candidate’s prospects. No one knows it better than President Barrack Obama. The Patient and Affordable Care Act enacted by Obama in March 2010 has helped him earn a second term. Also known as ‘Obamacare’, the Act is showcased as the Democratic candidate’s concern for the average American’s total healthcare.

The new Act put in place comprehensive reforms that would allow affordable health coverage for everyone and also protect citizens from abusive insurance company practices. No doubt, the political opposition didn’t take it lying down. There were huge protests from those not willing to pay an extra 13 per cent tax. But Obama and his party stood their ground.

It is interesting to learn that the US government spends 16 per cent of its GDP on health while India, with larger health issues, spends only 1.2% which has been increased to 1.85% for the Twelfth-Five-Year Plan. Take a look at the statistics to see how grim the situation is. Nearly 23 percent of Indians do not visit a doctor because they can not buy medicines; 25 per cent babies are born underweight; 30 per cent children are anaemic, besides 70 per cent of pregnant women and 24 per cent of adult males. Bed availability is less than one per 1000 and the country is short of 4000 Primary Health Centres (PHCs) and 23,000 sub-centres.

The country’s Infant Mortality Rate (IMR) at 50 per 1000 and Maternal Mortality Rate (MMR) at 212 per lakh births are among the highest in the world while the rate of reduction of IMR & MMR at 2.25 per cent is much slower than the global average of 4.4 per cent a year. The country’s planning body claims to be sensitive about these ‘gaps’ in health services and its solution to fill these gaps is by privatization.

Obviously, private players will charge for the services, may be, a little less than the market rate. For example, an MRI investigation in a Delhi government hospital costs Rs 3,000 instead of Rs 6,000, but even this is unaffordable for most patients.

The disastrous results of privatisation in the health sector has forced China to abandon it. Since the demographic profile of India and China are similar, it makes sense for India to learn from the Chinese experience. With only 15 per cent people covered under insurance or health protection scheme, either private or public, we are way behind China’s 56 per cent. India declared Rashtriya Swasthya Bima Yojna (RSBY) plans to cover 85 per cent of its unorganized work force. But the scheme is built on a defective foundation. The concept has arguably failed to find takers thus turning it into an Utopian ideal.

A more pragmatic approach will have to be conceived. In the present scenario, 75 per cent of health insurance premium is contributed by the Centre and 25 per cent by the state. This entitles the family an insurance sum of just Rs 30,000 anually.  In a high-inflation economy like ours, it should be at least Rs 100,000. For such a favourable offer, even the villagers and manual labourers will not mind paying Rs 10 per month for their healthcare. And now the game changer: the government must ensure prescription and availability of generic drugs instead of branded ones. But for that, the quality control apparatus in India needs a thorough revamp.