Top two myths of Indian Healthcare

I often hear that in India poor people are being pushed deeper into poverty when they have to pay out of their own pockets for healthcare, especially when they avail of private healthcare.

We also often hear about the “high cost of healthcare” in the private sector in India which services 70% of India’s healthcare needs.

What are the solutions we hear being proposed by almost every stakeholder?

Universal Medical Insurance
Increased Government spending on Healthcare

Let me try to explain why these are definitely not the best things that could happen to Indian healthcare @drspmathew.com

Whats wrong with Universal Medical Insurance [UMI]?

If there is one thing we know for sure from the experience of other countries, it is this: Universal Medical Insurance ensures in the long run that no middle class or poor person will be able to afford medical care without Medical Insurance. In a sense, UMI does everything to ensure its own survival!

Why does that happen? There are several factors:

Behavioral changes:

When people do not have to pay for their own healthcare: Have you thought through the way people approach their own health when they know they are covered by Medical Insurance and they believe they need not worry about taking care of their own health, especially in terms of the non communicable diseases NCD’s which are the leading causes of death? worldwide? http://www.who.int/mediacentre/factsheets/fs310/en/index3.html

When people have medical insurance and do not have to spend for their own healthcare, it encourages a very casual approach to their own health, which is fueled by the media hype about how medical technology is able to treat every known disease on earth. So, the common attitude is, I have insurance, so no problem. If I fall sick, I am covered by insurance, and medical technology will make me alright. Wrong thinking, friend!

The incidence of NCD’s have skyrocketed in all developed countries and increasing even in the developing countries. There are multiple reasons for this rise but behavioral or lifestyle disorders are so called for a reason: Bad behavior causes bad health, and the false sense of security that insured persons have is a major cause for this behavior according to me.

As a result of this increasing burden of NCD’s, Insurance companies keep increasing the premiums, and the overall burden on healthcare increases dramatically. [Read more on The Relation between Universal Health Insurance and Cost Control http://www.nejm.org/doi/full/10.1056/NEJM199503163321111 ]

Disruption of Free Market economics:

Mediclaim and other forms of Medical Insurance try to dictate pricing based not on actual costing studies but on a collective bargaining with providers. Paradoxically this has been shown to raise healthcare costs rather than bring them down as one would have hoped.

On the other hand, when people do not have medical insurance and must spend on healthcare out of their own pockets, they take all steps possible to avoid getting sick in the first place. They also behave more responsibly to take care of their own health and are very cost conscious.

This cost consciousness enables enabling free market economy forces in the healthcare sector to keep costs low without unnecessary bureaucratic intervention. This is what has been happening till now in India to a large extent.

Whats wrong with Increased Government spending on Healthcare?

What really happens when the Government tries to step in to provide Healthcare?

The US spends 17% of its GDP on Healthcare. India barely 4%. Per capita annual Healthcare spending in the US is 8600 US Dollars which equals 551195.50 Indian Rupees, while in India and other such countries, annual average healthcare spending is 88 US Dollars which equals 5641.23 Indian Rupees.

Rising healthcare costs in the US force a major rethink on strategy

In the real world, healthcare costs skyrocket when the Government and Medical Insurance companies step in. All that they are concerned about is their own survival.

When left to the economies of the free market as with any other industry or business, the price of healthcare will remain reasonable, access and quality will be determined by market forces, and there will be no opportunity for corrupt Governmental agencies to dictate their own often selfish agendas. I am not denying that there are several good people in the Government who sincerely believe that they are trying to do good, but the vast majority do not understand the realities and complexities of the healthcare system.

The Government, instead of wasting tax payers money in areas which are not its core competencies, should rather focus on providing basic things needed for health, starting with good infrastructure and a lot more! In these areas the Indian Government can do well to learn from the developed world!

But why do poor people in India find healthcare expensive?

Poverty is a big problem everywhere but more so in India. Is the healthcare industry responsible for poverty? A better question would be to ask, why are these people poor? And why are they falling sick?

Many poor people in India fall sick and die, because the environment and infrastructure essential for good health were not adequately provided for by the government and other agencies responsible for the same.

Poor people in India

The Government also did not provide a conducive environment for businesses to function transparently and efficiently, resulting in corruption and low wages for the workers. Of course there are diverse reasons for low wages, each of which is equally responsible for the poor person not being able to pay for healthcare.

The result: Poor people living in unhygienic conditions, getting underpaid for whatever work they do.

And when they fall sick, where do they go? Government healthcare, if available, is crowded and not free either. They lose days waiting in line, losing what little income they earned. So what alternative do they have? Private healthcare, that is fast, efficient, and much cheaper than any healthcare anywhere in the world. Why? Because when the pricing of healthcare is left to market forces, competition keeps costs low as in any business in the free market economy.

http://www.hindustantimes.com/india/most-indians-prefer-private-healthcare-services-over-govt-hospitals/story-KSgqT0rqLIebKzq34wRbJJ.html

If this poor person cannot afford the fees at a private healthcare setup, something is drastically wrong in the economics. The poor person is not being paid adequately or unable to save enough.

So, who is really to blame for the poor sick man being pushed into poverty due to sickness? Who is responsible for him falling sick in the first place?

Is it not the Government, which has not provided him basic needs for good health like clean air, pure drinking water and good sanitation? Which has not ensured that he gets adequate opportunities to earn his reasonable livelihood?

Every person in India has a right to claim that the taxes he pays are adequately utilized, not to line the pockets of corrupt politicians through short sighted mega projects in ‘Government healthcare’, but to ensure a life of dignity to the poorest, with the basic needs for good health provided to every citizen of the land.

Let the Government focus on what it is paid to do, govern impartially and without corruption, rather than try to enter into Healthcare and muddle it up. In that way it would be doing a great favour to the health of its citizens.

The Government can mess up Healthcare even if it is relatively non-corrupt like in the developed nations. So one can only guess what is going to happen to Healthcare in India once the Government tries to do anything.

Private Healthcare Providers and the responsible Free Market:

I must salute the private healthcare provider, who despite the odds, is providing a reasonable level of service to large segments of society at a fraction of the cost worldwide. No doubt there are black sheep here also but the model is one that has a hope for a better future, bringing about Shalom Healing to people.

Let us stop blaming those who are trying to do good, and focus on the real culprits. The people get the Government they deserve, an old saying goes.

I hope I have made myself clear. Neither increased Governmental spending on healthcare nor Universal Medical Insurance is the answer dear friend.

Instead, if it really cares for the health of its people, let our Government take serious steps to improve the basic essentials for good health. Let it restore and improve the quality of our air, water, food and soil.

Let the Government eradicate corruption and red tape within itself, help honest businesses to establish and grow, thus providing people with a reasonable standard of living. This will help to not only improve the health of our nation, but to transform India into a world class nation. Hope better sense prevails in our country. Please pass this on to those who care. Jai Hind!

Air pollution increases risk of childhood obesity and diabetes

A few days back I saw thick black smoke emanating from an illegal roadside garage and stopped to see what was happening.

Illegal roadside garage emitting carcinogenic fumes

I was shocked to see two men from a roadside garage burning wires made of copper and insulated with PVC, apparently to extract the copper.

In the bargain they were spreading carcinogenic fumes over a residential area housing thousands of citizens blissfully unaware of the deadly air they were breathing.

What are the dangers, you may wonder?

There is increasing evidence for the role of environment in pathogenesis in many diseases. Children below 5 years of age and adults older than 50 years are most at risk. A global assessment of the burden of disease from environmental risks by the WHO has shown that 23% of global deaths and 26% of deaths among children under five are due to modifiable environmental factors. The harmful effects of air pollution on respiratory health are well-known to us and well-established. Air pollution has been linked to many non communicable diseases such as cardiovascular diseases, obesity, cancers and type 2 diabetes.

A new study has again underscored the dire need for a healthier environment. This study has suggested that exposure to ambient air pollution may contribute to development of type 2 diabetes through direct effects on insulin sensitivity and β-cell function. The study reported in the January 2017 issue of the journal Diabetes showed that exposure to elevated concentrations of nitrogen dioxide (NO2) and particulate matter (PM 2.5) had adverse effects on longitudinal measures of insulin sensitivity, β-cell function, and obesity in children at high risk for developing diabetes.

So what can you do?

Here is what I did.

I went to the people burning the wires and asked them what they were doing. They said they were burning wires to extract copper, and this was the first time they were doing this.

I told them the dangers of burning such things, not only on their own health but also on the health and lives of thousands of people staying around.

They immediately doused the flames with water.

Caught and educated

As a good steward of the environment, and a citizen of this nation, be alert and do your bit wherever you are. You will be blessed by the living God who sees everything and is no respecter of persons, dear reader.

Jesus would surely not approve of or tolerate any evil in the area where he lived. I consider myself to be an ambassador for Christ, and take responsibility for what is going on in the area where I live. So I do my bit to tackle any evil or injustice when I see it.

If each Indian were to do so I am sure India would be a much better place to live in, and future generations will be grateful.

God bless you and India.

Do post what you have done to encourage others.

Explorers kids Dance @ Christmas 2016

In celebration of the wonderful birth of Jesus Christ, King of Kings who became a human being and entered our world 2000 years ago, these children performed a beautiful dance.

Performed by children who are part of the Explorers club of Sunday school of Living Hope Church, it was choreographed by Divya and Racheal.

_dsc3290

Enjoy the wonderful performance!

Hackers, Cyberattack and other random processes

Researchers at Lancaster University, UK have taken a hint from the way the human lungs and heart constantly communicate with each other, to devise an innovative, highly flexible encryption algorithm that they claim can’t be broken using the traditional methods of cyberattack.

Information can be encrypted with an array of different algorithms, but the question of which method is the most secure is far from trivial. Such algorithms need a “key” to encrypt and decrypt information; the algorithms typically generate their keys using a well-known set of rules that can only admit a very large, but nonetheless finite number of possible keys. This means that in principle, given enough time and computing power, prying eyes can always break the code eventually.

The researchers, led by Dr. Tomislav Stankovski, created an encryption mechanism that can generate a truly unlimited number of keys, which they say vastly increases the security of the communication. To do so, they took inspiration from the anatomy of the human body.

In nature, different systems within a living organism often interact with each other, exchanging matter and energy. The interaction between two such systems (for instance, that of the human lungs and heart) can be described by a so-called “coupling function.”

aggies-anatomy-lungs-chiron-brain-heart-as-future-pineal-and-human-brain-twin-organs

Rather than relying on a single system for the encryption, the researchers decided to use two, and use the coupling function between them as the encryption key. Although somewhat laborious, this method has the advantage of creating an infinite number of possible keys, meaning that eavesdroppers cannot simply bruteforce their way into
sensitive information.

For the more technically minded, here’s how it all works. An information signal reaches the transmitter and is used as a parameter in the coupling function between two self-sustained systems, both generated inside the transmitter. The two signals are then sent over the public channel. At the other end, these two signals synchronize
with the receiver and, using a private key that contains information on the coupling functions, the algorithm can infer the original parameters and decrypt the information.

The scientists say that their method is highly resistant from noise, that it can easily transmit several signals at once, and that it is highly modular, making it suitable to a wide range of applications.

A paper describing this patent-pending algorithm appears in the journal Physical Review X.

http://www.gizmag.com/human-biology-unbreakable-encryption/31504/?utm_source=Gizmag+Subscribers&utm_campaign=94c7968484-UA-2235360-4&utm_medium=email&utm_term=0_65b67362bd-94c7968484-90398925

Life and its processes are really complicated. This somehow does not fit in with what is taught in schools these days, doesn’t it? We are taught that random mindless processes [taught to be Evolution] somehow created life in all its complexity. I guess it is time to revisit the foundations of our belief 🙂

Mumbaiites continue to breathe poor quality air, except in Borivali

As a citizen of Mumbai and a medical doctor, I am very concerned about the quality of air we breathe. The Hindustan Times reported today that the city continued to have poor air for the second day in a row.The pollutant-measuring indicator air quality index (AQI) fell from 224 on Monday morning to 220 by the evening, both falling under the ‘poor’ category. There was no change in minimum temperatures from Sunday, which was 4.5 degrees Celsius below normal.

545012-pollution

The System for Air Quality Weather Forecasting and Research (SAFAR) predicted an AQI of 220 for Tuesday as well. An AQI between 101 and 200 falls under the ‘moderate’ category, while that between 201 and 300 is ‘poor’ and beyond 301 falls into the ‘very poor’ category.

The Santacruz weather station, representative of Mumbai, recorded the night temperature at 16.4 degrees Celsius, similar to Monday and November 11, which has been the lowest November night temperature since 2012. The night temperature at Colaba, representative of south Mumbai was recorded at 22 degrees Celsius, a degree Celsius below normal.

Officials from the weather bureau said the current wind pattern over the city has led to cool temperatures and a decline in air quality. “From late Saturday night onwards, cool winds from the north-western parts of the country has led to a cooling effect,” said KS Hosalikar, deputy director general, western region, India Meteorological Department. “As a result, due to the process of inversion, cool temperatures have allowed pollutant particles to settle close to the surface. We expect these conditions to continue till Wednesday.”

Meanwhile, day temperatures were more than 2 degrees Celsius above normal as Colaba and Santacruz, both recorded 35.6 degrees Celsius as the maximum temperature. “During the day, the winds are not strong and this has allowed temperatures to rise. However, cool winds during the night are leading to a fall in temperatures,” said Shubhangi Bhute, director, Regional Meteorological Centre, IMD. “The gap between day and night temperatures can lead to health issues such as cough, cold and fever,” Bhute added.

On Monday, Malad was the most polluted location with an AQI of 307 (very poor), followed by Navi Mumbai at 303 (very poor). While majority of the locations in Mumbai recorded ‘poor’ air quality, Borivli had the cleanest air with an AQI of 132 (moderate).

As part of a citizens Forum called the New Link Road Residents Forum, http://www.newlinkroad.wordpress.com we have been pro active to ensure that Borivali and its near by areas are free from man made sources of pollution. We wish that more readers would be encouraged to take steps to combat this menace.

Choosing between a Smart or a Green city?

I asked a few people, including myself, to imagine what a smart city would be like for those of us living in 2016:

It should take us from point A to B in the shortest time possible, automatically deciding for us which route to take.

It should provide free and fast internet either wired or wi-fi access, of course, in every nook and cranny.
It should have charging stations in every public place to charge our power hungry smart devices
It should of course have electricity 24X7
It should enable seamless connectivity of all transport methods
All devices, cars, trains, buildings and people should be able to communicate with one another
Intelligent planning of facilities
Self-repairing roads, drains, and what not…etc etc

This picture of a smart city sounds like a tall order for us living in Mumbai, even though it is the commercial capital of India! It also sounds extremely power hungry.

But can a city be both green and smart?

What do I mean by a green city? It would be somewhat like a forest. For starters, a green city ecosystem, like a forest, is a scientific and design miracle. Each and every component is recyclable. Forests produce more oxygen than they consume, are carbon sinks and earn huge carbon credits silently, and they mutually help one another to thrive and grow, not just survive! The parts of this ecosystem are self-propagating, require almost zero maintenance, have sophisticated feedback looks both positive and negative, are self-diagnosing and self-repairing, adjust their position and growth as per various variables like the temperature, sunlight, wind, water availability and nutrients.

Wow, now that simple forest sounds really smart when you look at it in that way!

Okay, but no one can stay in forests, right? So what is the next best option? How about something that looks like this?

Imagine a smart and green city of dreams…

A city that is both smart and green? Some would dismiss this as a utopian concept, but I am confident that given enough freedom, creativity and encouragement, the future generation can create living spaces that are at once green and smart.

Let us see where we can start if we really wish for our city to be smart and green. I feel there are three very important pre requisites if we really wish to create a smart and green city:

Firstly, there has to be basic value and respect for human life and a recognition that life has a purpose. If life does not have a purpose, one might as well live in a filthy slum, who cares.

Secondly we must be humble enough to admit that there are designs in nature from which we can learn. The field of bio-mimetics has produced some extremely clever inventions by copying what God has created in his marvelous creation.

Thirdly there must be a culture that respects and encourages creativity, honesty and truth.

In such a city, there is no end to the possibilities that can be created, and a smart and green city would indeed be a reality. Hope we in India can reach that stage sooner than later. Jai Hind!

When the solution is worse than the problem!

If someone were to suggest to you that the solution to your headache would be to shoot your head off, how would that sound? I know it can sound absurd, but to me this whole debate about the solution being offered for the woman who is pregnant but does not wish to become a mother, the solution that the Medical fraternity is only too eager to offer in India especially, of aborting the life she is carrying, doesn’t sound too different.

What wrong did that unborn child do to be prematurely killed when it is in the most dependent state of its life? 3028478570_3efd46af8f

Justice K. Kannan who is a former judge of the Punjab and Haryana High Court wrote an interesting article in the Hindu recently questioning the way abortion is fast being offered as a solution to myraid cases of pregnancy: The fundamental question is: what makes killing a human being wrong? We may then consider whether these characteristics, whatever they might be, apply to the earliest stages of human life in the womb. Explanations that have roots in religion include the traditional Christian doctrines such as that all humans are made in the image of God or that all humans have an immortal soul.

Apart from the point of view of health and avoidance of disability, with modern notions of individual liberty, many a pregnant woman believes that apart from her, no one else will have a right to decide about what she wishes to do with the foetus.

61db688f098aef6302392c2ef9ee6b31

It is also suggested that an alternative for parents faced with the decision to terminate their pregnancy is a perinatal hospice. A perinatal hospice recognizes the value of bringing these infants to term by treating them as beings conceived with a tangible future. This alternative is preferred because of post-termination psychological distress and because biblical teachings emphasise the dignity and worth of each foetus.

In response to this, a few well educated people from India including female Medical Doctors wrote about choice: [http://m.thehindu.com/opinion/op-ed/abortion-womens-rights-and-human-rights/article8969843.ece]

“According to international human rights law, a person is vested with human rights only at birth; an unborn foetus is not an entity with human rights. The ethical issues here are not just of the rights of the foetus. The foetus is not an independent entity and depends completely on the welfare of the woman. Without her well-being, one cannot talk about the well-being of the foetus. We also need to consider the fact that the woman herself is a living human being in the here and now — the pregnancy takes place within her body and has profound effects on her health, mental well-being and life. Thus, how she wants to deal with this pregnancy must be a decision she and she alone can make.”

What even a school child understands is that there is life inside the bulging tummy of the pregnant woman.

The PCPTND act which forbids disclosure of the sex of the fetus in India, designed to thwart the warped sex ration in the country due to selective female foeticide over the ages, recognizes that there is life in the womb! Then what is the confusion?

I am reminded of a phrase: We have educated ourselves into imbecility. No wonder educated people can write such responses to the article written by Justice Kannan.

Perhaps this last image sums up my message:

choice

I would also like to add, the men who caused the pregnancy must learn to take responsibility for taking care of the outcome equally if not more.

I hope you would say Amen. Even if you do not, remember, the King who created you, and loves you, decides what is right and what is wrong, not me and not you. His Kingdom is advancing swiftly.

On which side would you be, my friend?

Learning to read…

Read at your own risk!

Author: Dr. S. P. Mathew