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?

  1. Universal Medical Insurance 
  2. 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.

Where do you think Insurance companies get the money to pay your Medical bills?

[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 and lower healthcare quality, 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 private 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!

Poverty and sickness:

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

Warped Economics:

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.

The WHO definition of Health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

The Government can do much more for the health of India if it focusses 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 favor 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!

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Quacks and Burkas

Imagine a Doctor advising a patient who has vomiting, to cover up all food and water in his home because the very act of looking at food makes him vomit, and vomiting is not good for health. What would you call such a Doctor? A quack, obviously! And you would ofcourse try to understand why there is vomiting in the first place, and treat it!

This brings me to a similar situation common to many parts of the world these days: covering up a woman in a burka or niqab to prevent men from lusting at them.

Why do some Muslim women wear burkas?

Raihan Ismail is a lecturer in Middle East Politics and Islamic Studies at the Australian National University. Dr Ismail spoke with 666 ABC Canberra to answer some common questions about the burka. The Koran calls for both men and women to ‘cover and be modest’ she said.

This is because being immodest can awaken lust, which is recognised as bad by most religions of the world.

So what is the only solution to the problem of lust?

The Bible tells us in simple and plain language that all of us were or are in this situation, following our heart and fulfilling the lusts of the flesh:

As for you, you were dead in your transgressions and sins, in which you used to live when you followed the ways of this world and of the ruler of the kingdom of the air, the spirit who is now at work in those who are disobedient. All of us also lived among them at one time, gratifying the cravings of our flesh and following its desires and thoughts. Like the rest, we were by nature deserving of wrath.

The Bible also talks of a people transformed from within:

But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions–it is by grace you have been saved. And God raised us up with Christ and seated us with him in the heavenly realms in Christ Jesus, in order that in the coming ages he might show the incomparable riches of his grace, expressed in his kindness to us in Christ Jesus. For it is by grace you have been saved, through faith–and this is not from yourselves, it is the gift of God– not by works, so that no one can boast. For we are God’s handiwork, created in Christ Jesus to do good works, which God prepared in advance for us to do.

(Ephesians 2:1-10 NIV)

The answer to the lust problem then is not in covering up the objects of lust, but dealing with the lust within your own heart.

Easier said than done? Here is how it is possible:

So I say, walk by the Spirit, and you will not gratify the desires of the flesh. For the flesh desires what is contrary to the Spirit, and the Spirit what is contrary to the flesh. They are in conflict with each other, so that you are not to do whatever you want. But if you are led by the Spirit, you are not under the law. The acts of the flesh are obvious: sexual immorality, impurity and debauchery; the list goes on. (Galatians 5:16-19 NIV)

The Spirit of God is a wonderful gift that God gives to those who have repented of their sins and accepted the free gift of forgiveness offered by God through the substitutionary sacrifice of the sinless man Jesus Christ.

That is why the Apostle Peter could write two thousand years ago:

Simon Peter, a servant and apostle of Jesus Christ, to those who through the righteousness of our God and Savior Jesus Christ have received a faith as precious as ours: Grace and peace be yours in abundance through the knowledge of God and of Jesus our Lord. His divine power has given us everything we need for a godly life through our knowledge of him who called us by his own glory and goodness. Through these he has given us his very great and precious promises, so that through them you may participate in the divine nature, having escaped the corruption in the world caused by evil desires. (2 Peter 1:1-4 NIV)

God has created man and woman as precious, wonderfully different and yet equal in His eyes.

We all have been born with a default mode that is damaged, with the tendency to sin and lust. I am sure all of you have experienced that, in yourselves and in others.

Yet the amazing fact is that despite knowing us, God loves us, and has made the provision for us to ‘participate in His divine nature’, and overcome every evil in our hearts. The way is simple and effective.

So dear friends, do you feel that covering up women or the opposite sex is the solution to the problem of lust?

Religion tells us to follow rules and external conformity, hoping that will solve the problem of lust and other evils. God tells us to change our heart from within. You decide J