21 December, 2020
7 Min Read
Analysis of Healthcare in India
India’s health care is a dark echo chamber.
It is 70% private and 30% public in a country where 80% people do not have any protection for health and the out of pocket expense is as high as 62% (i.e Government does not bear much for public healthcare).
With public spending at 1.13% of GDP and a huge shortage of healthcare workers particularly nurses and midwives, policy moves and plans appear like a sound in emptiness.
The novel coronavirus pandemic has revealed the mismatch between the overwhelming presence of the not so well to do and private health care with its revenue modelling that borders more on greed and rent gouging.
The fact is 85% of the population cannot afford high cost, corporate private health care.
While too little is being done too slowly to have any impact, private hospitals gain under the social insurance scheme in the interregnum.
Even with avowedly 12 crore card holders under Ayushman Bharat, only 1.27 crore people have taken advantage of the scheme.
In health economics,where competitive equilibrium often does not exist, the behaviour of a private corporate hospital is skewed in favour of profitability. Any attempt to cover the non poor and the rich will result in advantageous selection for those better-off crowding out the poor.
India’s health problem has a 80:20 rule; 20% of people can afford modern health care, 40% cannot afford it at all and the other 40%, the so called non-poor, pay with difficulty.
Because of the problem of access, affordability, absence of quality manpower and the rent seeking behaviour of staff, more than 80% of people routinely reach Registered Medical Practitioners who are not trained to treat patients. But they routinely prescribe antibiotics and steroids for quick relief.
The country could be sitting on a dormant volcano of antibiotic and steroid immunity.
There are three options here. Ramp up the number of doctors with counterpart obligation to serve in rural areas.
Second is to revive the Licentiate Medical Practitioner as we had before Independence in the rural areas.
The third one is to empower graduates of BSc (Nursing) to benursing practitioners .
While the primacy of primary health care is emphasised by everyone, work on the ground does not bear it out. Admittedly, it is the critical piece of health care but government funding is disturbingly skewed against it.
Primary healthcare should receive three times more allocation in the budget and doctor and paramedic strength should be doubled merely on the basis of population increase.
But the most important thing is that States should be incentivised to carry out the appointments of health workers and doctors.
The ratio of 0.6 nurses per doctor while the World Health Organization specification is three nurses per doctor.
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