Reflections on Republic Day—India needs universal health care

If billboards are any indication of economic activity in a place, then the two businesses that seem to be doing well in Bengal are gold jewellery and healthcare. A city like Kolkata is plastered with advertisements of gold boutiques and private hospitals promoting specialised treatments.

On my way to work every morning, I pass two old hospitals. The first is run by a charitable organisation. The second is a government post-graduate medical college and hospital, at one time reputed to be one of the finest in eastern India. The charitable hospital still remains popular with common people for quality services at reasonable cost. However, being a non-profit establishment, they have over the years kept their facilities limited to general medicine and basic level of specialisation. Chronic trade union problems have dissuaded them from expanding the scale of operations.

In the past, the government hospital had very reputable specialists—much like AIIMS in Delhi. It was particularly well known for certain departments like Cardiology. I remember many family members opting for treatment there in preference to private hospitals.

The same was true for the famous Calcutta Medical College that has produced some legendary physicians and surgeons. Professors of CMC or its associate School of Tropical Medicine used to be pretty much the last word on medical diagnosis.

That was not all. West Bengal had a large number of Tier 2 and Tier 3 government run hospitals and Medical colleges that were considered first class, may not be in terms of facilities but in the quality of medical education and treatment.

One need not belabour the point of all round decline of the public healthcare infrastructure. Also, it is not fair to single out West Bengal for the pathetic state of its government hospitals. This is a national phenomenon. Analysing the root causes can be the subject of a Doctoral thesis.

Nowadays, the only patients who go to state run hospitals by choice are VIP political detainees and economic offenders on the plea of serious medical condition to escape police or judicial custody.

Unlike hospitality and aviation, for which privatisation is argued, it cannot be said that healthcare is not the state’s responsibility. However, it is true the government alone cannot do the job and private players have to be allowed into the healthcare space. But, that does not mean – the promise of “universal healthcare” can be entirely outsourced. Unfortunately, that is precisely what is happening whether by default or design.

If the collapse of government hospitals has been caused by poor work culture and corruption, private hospitals are plagued by lack of professional ethics. It is well known that there are nexuses at play right from the level of drug manufacturers, equipment vendors, implant suppliers, hospital administration, clinical laboratories and doctors. Health insurance companies complete this vicious circle by spreading the cost of the scam over a wider base of policy holders.

Further, most private hospitals dodge taxes by declaring themselves as medical research institutes and often rewarded by the government by grant of land free or at hugely concessional rates. Not surprisingly, politicians indirectly own many of these trust run hospitals.

Some friends from the medical fraternity try to justify the state of affairs saying that, these scams are not unique to India. But, that is little consolation for the common man who pays for these services. What medical insurance has done, ironically, is to raise the overall cost of healthcare. Also, even assuming their allegations have some substance it is still fallacious because, in those developed countries even the poorest man has access to some level of basic healthcare like through the NHS in Britain.

Therefore, despite the so-called “Mediclaim” insurance, customers end up paying large sums out of their pocket. Besides, in India cost of medicines and clinical tests for domiciliary treatment are not covered by insurance and that constitutes bulk of healthcare costs.

This has huge socio-economic implications. With large scale displacement of workmen and even white collar employees from the organised sector, vast majority of the population do not have the benefit of any corporate medical cover. At the same time, as general human longevity increases, retired senior citizens with their measly pensions and superannuation find themselves in a hapless situation.

This phenomenon is not restricted to the cities alone. The state of rural healthcare even after 70 years of independence is a matter of national shame. With the condition of government hospitals in the districts being what it is—the private medical rackets have spread to the hinterlands finding easy prey in poor villagers.

The solution, therefore, lies in effective regulation. At present, though there are separate laws governing different aspects of healthcare, like drug control. But, a holistic approach is lacking that will make quality healthcare accessible and affordable for all. The need of the day is a comprehensive policy that will take into account each element of the healthcare “value chain”—starting with the standard of medical education and certification for medical practitioners.

Sporadic intervention on drug prices and the odd litigation on medical negligence are a poor substitute for a larger and effective legal framework. At present, the government seem to be highly focussed on promoting alternative systems of medicines – like Ayush, Yunani and Homeopathy. While these can supplement mainstream healthcare, they cannot replace them.

Setting up a few AIIMS across the country to appease regional political constituencies is mere tokenism. Besides, without a plan the AIIMS Branches too will soon be reduced to the state of other government hospitals.

While opening up the healthcare sector to private players, the government cannot abdicate its own responsibility. Failure to provide equitable access to healthcare for every strata of the population, shall not only affect the national productivity and quality of life of our citizens but also create further inequalities in society in the name of economic liberalisation.

Sandip Ghose is a marketer and writes on current affairs. He tweets at @SandipGhose and blogs at Right Angle: www.sandipghose.com. Views expressed are personal.