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.

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.

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.

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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?

Yoga…the great if only….

If only Yoga lived up to even 1% of its claimed benefits, what a different nation India would have been….many tourists to India have often wondered. And for good reason, as you will discover.

But for now, here is something that will surely pique your curiosity!

United Nations General Assembly has declared 21^st of June as an International Yoga Day on 11^th of December in 2014.

The declaration was done after the call by the Indian Prime Minister, Narendra Modi to the United Nations General Assembly on 27^th of September in 2014 during his address to the UN General Assembly. He called the United Nations General Assembly for adopting 21^st of June as an International Yoga Day to get all the benefits of yoga for the people all around the world. [http://www.indiacelebrating.com/events/international-day-of-yoga/]

Narendra Modi has said during his address to the UN General Assembly that “Yoga is an invaluable gift of India’s ancient tradition. It embodies unity of mind and body; thought and action; restraint and fulfilment; harmony between man and nature; a holistic approach to health and well-being. It is not about exercise but to discover the sense of oneness with yourself, the world and the nature.

A look at India would make us wonder, how on earth does he have the guts to make such tall claims?

Restraint and fulfillment? Harmony between man and nature? Yoga has been practised for centuries in India. Where rivers are treated as dumping grounds for all sorts of garbage, sewage and even dead bodies. Where forests are being destroyed, mangroves reclaimed, the air and water polluted.

So what is this Yoga?

Derived from the Sanskrit word yuj, Yoga means union of the individual consciousness or soul with the Universal Consciousness or Spirit.

There are many more people making tall claims for Yoga.

A renowned Hindu Guru Sri Sri Ravi Shankar, from India, says “Yoga is not just a physical exercise or asanas. Yoga is a complete science. It unites the body, mind, spirit and the universe. Yoga brings that much needed peace in every individual. It also makes a big difference in one’s behavior, thought pattern and attitude. I would say yoga is almost indispensible. If you want to be sane, sensitive, sensible, strong and intuitive you have to follow yoga.”

Now think of the state of the majority of the people in the world. Does he mean to say that they are not sane, sensitive, sensible, strong or intuitive?

Or let us take the other side of this.

What has Yoga done for India?

How many would look at India, the place where Yoga was founded, and say Indians have that much needed peace, and exemplary behaviour, thought patterns and attitudes?

India is one of the most corrupt countries in the world, and also considered backward in hygiene, health, equal rights to minorities, women and children, and even in sports. A mere look at the Olympic Medal tally of India will reveal what this so called Yoga has done to help Indians achieve superior physical strength, stamina or health.

So in terms of peace of mind, values, ethics, or in the more measurable physical health, yoga has not been of any use practically to the countless millions of Indians.

Then why is it being propagated?

That is a good question, that the Prime Minister and the present right wing Indian government should be answering.

I believe there are deeper spiritual reasons why Yoga is being propagated.

Yoga promotes the pantheistic world view that everything and everyone is god, and the aim of Yoga is union with this so-called force or god. Is this logically, scientifically and factually true? Ofcourse not! The Creator, whom we would call God, is not a force without any personality or feelings! He is a person, and that is why He made us humans in His image, and He shows us His love. A force or the god consciousness to which Yoga proponents would have you unite, it cannot and never will love you!

The Judaeo-Christian world view clearly states that God is the creator and everybody and everything else is created by Him and distinct from God. The very first temptation faced by humans [Genesis 2-3] was to be like God himself, the very same thing offered by Yoga. Of Course, God was displeased by this heresy and had to punish Adam and Eve, but He [out of His immense love for us] also made a way for us humans to be restored back to a relationship with Him, through repentance and faith in the finished work and atoning sacrifice of Jesus Christ, God who became a man to take on Himself the punishment due to us for our sins.

Yoga and its spiritual philosophy tries to deny that we humans are sinners, separated form the God who created us. This is nothing but the lie that satan used in the garden with our very first parents.

Another area of concern in yoga is the concept of emptying the mind, which is contradictory to what Christianity teaches. As Laurette explained, “We are transformed by the renewing of our minds, not the emptying.” Emptying the mind leaves it open to other spirits to take control of the person’s mind, and that is what often happens.

So please be wise before accepting anything. There can be dangers far worse that you could have imagined.

For more reading, please visit these sites:

http://www.todayschristianwoman.com/articles/2005/march/truth-about-yoga.html

http://www.praisemoves.com/ offers excellent and spiritually safe exercises without exposing you to mind emptying spiritual dangers.

http://caryl.tv/

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Don’t waste time, Doctors say

Heart attack to hospital takes 5 hours in Mumbai

Doctors To Try & Cut Down Time Taken In City [Adapted from a front page article dated May 25 2014 : The Times of India (Mumbai)]

With three million cases every year, heart attack may be the commonest grave ailment in India. But Indians seem to be dimly aware of its calling card—be it the sudden pain in the chest, upper back or jaw—and often don’t react appropriately. A shocking 95% of heart attack patients take public transport to reach hospital. And, many of them reach after six hours—or over 380 minutes—of the first symptoms, found an all-India study.

Cardiologist Dr Prafulla Kerkar, who heads KEM Hospital’s cardiology department, said barely 10% of heart

attack patients in the city reach the hospital within the golden hour. The golden hour is the crucial period in which medical treatment can prevent permanent damage to the heart’s muscles.

“A study among 350 of our heart attack patients showed that 10% reached the hospital 12 hours after the attack. By this time, the advantages of restoring blood flow are lost,” said Dr Kerkar. The majority of the patients took a median time of five hours, which is twice as long as it takes in the West.

It is to reduce this time lag between the appearance of symptoms and hospitalization that a handful of cardiologists have come together to form a not-forprofit organization called STEMI India.

Three years ago, STEMI India brought together doctors, hospitals and ambulance providers in Coimbatore and Chennai to spread awareness about heart attacks and ensure that patients got treated within the golden hour. They have succeeded in reducing the average symptom-to-hospitalization time to less than three hours or 170 minutes so far.

Next weekend, the STEMI India group of which Dr Kerkar is a member will hold its first training programme in Mumbai at Powai. “Over 800 doctors from Maharashtra, Goa, Gujarat and Madhya Pradesh will attend it,” said course director Dr Rajesh Rajani, cardiologist from Hinduja Hospital, Mahim.

“The message is that the longer you take to report to a hospital after a heart attack, the higher the chance that you are left a cardiac cripple who may well need repeated hospitalizations later on,” added Dr Rajani. It is now well established that patients who are given immediate medical treatment–say, a blood thinner or clot buster–may not suffer any long-term effects of a heart attack.
Many hospitals and nursing homes in Mumbai, though, still don’t give a clot-buster to a patient who comes in with suspected heart attack, say doctors. “They refer the patient to a bigger hospital without even providing streptokinase injection that can dissolve blood clots that caused the heart attack,” said Dr Kerkar. Ashok Hospital is one of the few Hospitals that give this vital clot busting drug, and Dr. S. P. Mathew encourages other Hospitals around to do the same.

Drinking water or Sewage?

Civic body faces takeover if Ulhas River remains polluted

This is really shocking. Does the Municipality and Maharashtra Pollution Control Board [MPCB] have to be told to do this? Drinking water is a basic requirement for everybody. What is stopping them from destroying he life of millions of innocent people? I am glad that my friend and fellow activist Stalin Dayanand has taken up this vital issue through his NGO Vanashakti.

TIMES NEWS NETWORK

14^th May 2014 The Times of India

Figure 1 Untreated waste dumped into rivers

Mumbai: The Ulhasnagar Municipal Corporation (UMC) was on Tuesday warned by the Pune bench of the National Green Tribunal (NGT) that it will have to stop discharging untreated sewage and effluents into the drinking water source of Kalyan-Dombivli.
The tribunal gave three months to the municipal corporation to clean up its act, failing which “it would be constrained to direct the secretary, urban development department to exercise powers under the Maharashtra Municipal Corporation Act to control the corporation and deal with the problems of pollution in the area”.
NGO Vanshakti had filed an appeal before the NGT to restore the Ulhas river, which was seeing discharge of untreated effluents from MIDC industrial estates, seriously affecting the health of people in Ambernath, Badlapur, Ulhasnagar, Kalyan-Dombivli and elsewhere.

Figure 2 Criminal discharge of effluents into water bodies

The NGT observed that information provided by the Maharashtra Pollution Control Board showed there was no sewage treatment plant (STP) provided by the Badlapur Municipal Council.
The NGT order read: “It also appears that Ulhasnagar Municipal Corporation, has provided STP of very low capacity, which does not take care of sewage generated….”
The tribunal said in view of the submission by the MIDC that the process of laying pipelines in the sea-bed to discharge effluents would take time, it directed the UMC to divert Khemni nala to avoid discharge of sewage and effluent in the river or water bodies.

The Ulhas river sees discharge of untreated sewage and effluents

Learning to read…

Read at your own risk!

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