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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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.
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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.
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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).072813_1339_4.png

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.

Fun with Liquid Nitrogen in Mumbai

Fun with Liquid Nitrogen in Mumbai
Imagine being able to have liquid nitrogen which is minus 196 degrees Celsius right in your home! For experimenting with, ofcourse. Nitrogen Utsav (56)The team with the various experiments they did.

They started with introducing themselves, Science Utsav, a company, started 4 years ago in Bangalore. Then they invited questions from the children and parents alike. The first experiment was one of pouring out liquid nitrogen into a plastic beaker and putting a fresh rose in it. Nitrogen Utsav (30) Nancy was told to crush the rose and it powdered in her hands!

After this there were various experiments with different objects like cricket ball, banana, chikoo, balloons and Amul cool Milk. Nitrogen Utsav (20)

Pouring Liquid Nitrogen

Pouring Liquid Nitrogen

Yes that is what some of us Mumbai Homeschoolers got to taste, literally of course, at Liquid Nitrogen Science fun organised by Science Utsav, a company that organises science themed birthday parties too.
We met at our home on the 14th of October 2015. There were around 35 of us including a few parents.

Frothy fountain

Puking Volcano

 We also got to see this Puking volcano!
IMAG6082

Pouring out Liquid nitrogenIMAG6118

Experiments in full swing.IMAG6132

Children lining up to get a taste of instant icecream made right before their eyes!

Everyone enjoyed and learnt a lot of physics, chemistry and biology as well! Three cheers to homeschooling and science Utsav!

More parents take to home-schooling their kids, term school studies as rote-learning

Children have always learned naturally from grandparents, parents and elder siblings by accompanying them to the market, to the jungle, to the river, or to the fields. Helping with daily tasks of sowing, harvesting, hunting, food gathering, wood cutting, thatching, attending cattle and so on… children acquire valuable knowledge about biodiversity, medicinal plants, animal husbandry, agriculture, water conservation, house construction, fishing, pottery, weaving, painting … That is EDUCATION!! http://ancientroots.in/children-tomorrows-custodians-of-traditional-knowledge-part-1/

Now it looks like city dwellers have caught on to this and are taking on to homeschooling in a big way. Here is an article in the Times of India by Freny Fernandes….

Seven-year-old Aditi Choudhary is intensely poring over a copy of an atlas and correctly spells out the capital of all nations on the globe when asked. After a pat of appreciation, she resorts to learning math. Nothing out of the ordinary, except that Aditi is getting her lessons at home and not in school for the past three years.

She is being home-schooled, just like the growing number of other children whose parents have taken responsibility as teachers, instead of sending their wards to school for what they call rote learning.

“The schools are preparing them for a rat-race. It is not about gaining knowledge these days. It is all about rote-learning and preparing them for a job market. I do not subscribe to this concept,” says Maya Choudhary , Aditi’s mother.

Shubhangi Bagul, an artist and resident of Louis Wadi, is determined to pull out her fouryear-old son from a school in Thane after a year of observing the way he was being taught.

“We enrolled our son in the junior KG of a popular school with lots of hope. The first thing that disappointed us was that it was overcrowded with 68 children and one teacher to handle them. The school’s approach was a very standard, one-size fits-them all pattern where a child’s natural instinct takes a beating,” she says.

Shubhangi’s husband, Chetanraj, also an artist, says that he wanted his son’s ability at creativity, imagination and understanding to be nurtured and sharpened. “Home-schooling is an alternative education system that can allow holistic growth, “ he says.

Most of the 500-group of parents from Thane and Mumbai who are home-schooling their children say that taking on the role of a teacher requires 100 per cent commitment.

Shruti Patil, who took an infinite sabbatical from her career in architecture to homeschool her three daughters, says, “I have not gone to work ever since I took the responsibility of teaching my children. Every night I have to think of ways to teach basic concepts to them in an interesting way. I even took a course on phonetics from Deborah Rodrigues to understand it better before teaching them. I am constantly reading up on child psychology, etc. to help me teach them better. “

Adapted from May 17 2015 issue of The Times of India (Thane) by Freny Fernandes.

Marching to save Mumbai’s rivers

On 1st March 2015, More than 800 Mumbaiites dedicated their Sunday morning to walk the extra mile for the city’s rivers, literally.

As part of the March Walkatahon, people of all age groups, including 300 school students from Rustomjee school, marched along the 5-km stretch of the Dahisar riverfront to raise awareness about the poor state of the city’s polluted rivers and the need to conserve them.

The walk began from the Rustomjee International School and passed through Dahisar village. “The march was an effort to create awareness among people not to pollute the Dahisar river” said Mahesh Thawani, one of the organisers and member of the River Rejuvenate Regiment.

With most of its stretches now resembling a large, dry drain, the 12-km river originates from the Tulsi Lake near Kanheri caves and empties into the Mira Bhayander creek.

Such has been its degradation over the years that locals seem to have forgotten it was once a river and call it a ‘nullah.’ The waters are dark and stink with sewage, the course is choked with plastic and construction work is going on in various parts of the dried-up river.

Dr Shubha Raul, former mayor of Mumbai, who has been associated with the issue of degradation of rivers for the past 13 years, said: “I had taken samples of all four rivers and submitted it to NEERI [National Environmental Engineering Research Institute]. Their study stated there was very little oxygen and the acid level was too high for any marine life to survive in these rivers.”

Indira Bhende, a 75-year-old pioneer who has been fighting for the river since 1997, said, “I was part of a project that had gone to the MMRDA in 2002 with regard to cleaning up the river, but nothing came of it. Today, I am glad people are taking initiative.”

Dahisar resident Manish Sharma said, “We have only heard stories about how beautiful this river used to be. I am here today because I want to the see the same through my own eyes someday.”

The citizens have decided to continue the river march on an annual basis and the project is aimed at rejuvenating the rivers by 2020.

  • 2 Mar 2015
  • Hindustan Times (Mumbai)
  • HT Correspondent htmetro@hindustantimes.com

Who is trying to rewrite Indian History?

24 Sep 2014, Hindustan Times (Delhi), SITARAM YECHURY the views expressed by the author are personal

Ignorance, lies posing as truth

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The RSS, in its effort to convert our modern secular democratic republic into a ‘Hindu rashtra’, is trying to rewrite our history.

The latest incident of the dismissal of 11 Dalit students from a BJP state government-run school in Bikaner, Jaipur, on the grounds that they were drinking water from an earthen pot earmarked for an upper caste teacher once again highlights the continuing caste and social oppression in our country. It is indeed the irony of our times that on the same day the RSS chief released three books authored by a BJP spokesperson, carrying forewords by three top RSS leaders attributing the genesis of Dalits, tribals and many other oppressed groups to “Muslim invasion in medieval times”. RSS leaders claim that these castes had come into existence due to atrocities by foreign invaders and did not exist in Hindu religion earlier (The Hindustan Times, September 22, 2014).


REUTERSThe origins of the RSS itself are based on the religious sanction of the ‘Hindu code’ which the most sacrosanct of RSS sarsanghchalaks, Madhav Sadashiv Golwalkar, endorsed

The RSS emboldened by the central government under its political arm, the BJP, has intensified its efforts, to validate a common Hindu thread to unify all groups under one Hindu identity. For this, it is essential that the history of the lands constituting our great country today is rewritten according to their narrative. This is essential for carrying forward the RSS ideological project of converting the modern secular democratic Indian republic into their conception of a ‘Hindu rashtra’. The entire diversity of culture, traditions, language and customs of the people who have inhabited India over the centuries is sought to be straitjacketed into a monolithic ‘Hinduism’. Secondly, an external enemy (i.e. external to Hindus) needs to be created — the Muslims — against whom a hate campaign can be whipped up for achieving this objective.

In this latest exercise of rewriting history, Bhaiyaji Joshi, the second in command in RSS hierarchy, says that the ‘shudras’ were never untouchables in Hindu scriptures. ‘Islamic atrocities’ during the medieval age resulted in the emergence of untouchables, Dalits and Indian Muslims.

Echoing a similar tune another top RSS functionary writes that the oppressed castes and sub-castes came into existence as a result of atrocities against Brahmins and Kshatriyas during the Islamic age, “Dalits had the genesis during Turks, Muslims and Mughal eras”. Focusing on such lines of rewriting Indian history, media reports that one of the RSS affiliates recently convened a conclave of over hundred historians to discuss historiography and changes (in our syllabi), to construct an overarching Hindu identity beyond any caste or sub-castes in order to achieve the objective of Hindu consolidation.

That the caste system and the accompanied social atrocities never existed in ancient Hindu society and were the creation or the incorporation into such a society by Muslim invasions is a gross distortion of recorded history as well as the rich experience of oral historiography that has run through millennia in these lands. In fact the origins of the RSS itself are based on the religious sanction of the ‘Hindu code’ which the most sacrosanct of RSS sarsanghchalaks, Madhav Sadashiv Golwalkar, endorsed. In a 1939 tract titled ‘We or Our Nationhood Defined’, Golwalkar acclaims Manu as the “first and greatest law giver of the world” who “lays down in his code directing all the peoples of the world to go to Hindustan to learn their duties at the holy feet of ‘eldest born’ Brahmins of this land”. In a much later work, the Bunch of Thoughts (1966), he says “Brahmin is the head, King (Kshatriyas) the hands, Vaishya the thighs and Shudras the feet. This means that the people who have thus, four fold arrangement, i.e. the Hindu people is our God.”

Now what does the Manusmriti say? “Serving Brahmins alone is recommended as the best innate activity of a Shudra; for whatever he does other than this there is no fruit for him” (Chapter X, 123). The Manusmriti then proceeds to define the outcastes and untouchables who have no place in society at all and defines their menial activities. This intolerant caste structure finds expression in the RSS today as the Manusmriti is exclusively based on ‘Aryan social organisation’. “Un-Aryan behaviour, harshness, cruelty and habitual failure to perform the rituals are the manifestations in this world indicating that a man is born of a defiled womb” (Chapter X, 58).

The establishment of such a ‘Hindu rashtra’ however, requires incontrovertible proof that Aryans originated from these lands alone and did not come here from anywhere else. All questions of historical evidence are brushed aside by the RSS, by an assertion of ‘matters of faith’. Historian Romila Thapar, establishes that “the linguistic evidence of Vedic Sanskrit supports the coming into India of an Indo-European language from Iran but does not support the notion that India was the homeland of the Aryan speaking people”. (Seminar, 400, 1992). All this is brushed aside as ‘faith’ takes over evidence, mythology over history and theology over philosophy.

In India, Hinduism enforces poverty on those labelled ‘untouchables’. To help people most in need of help brings ‘bad karma’ on you personally (because you are interfering with the ‘law’ of karma where the station of a person in this life is due to their deeds in a former life), so people do not have a reason within their religion to help others in need, etc.

It is the tenacity of such a criminally oppressive social order that continues to perpetuate gross injustices in India today. According to a report published by the ministry of labour in 2001, (the last of its kind), 15% of the population constituting the three upper castes (Brahmins, Kshatriyas and Vaishyas) with no legal reservations occupy 66.5% of political representation, 43% of education, 87% of employment, 97% of business and 94% of landed estates. The rest of the population consisting of the OBCs (Shudras), the SCs and STs, along with the Muslims, with a population share of 85% share the rest in hopeless conditions of inhuman inequality. This social order has to be overthrown to begin the struggle for justice.


The RSS/BJP’s agenda of rewriting Indian history is designed to perpetuate such unacceptable levels of social oppression along with the denial of basic human rights for anyone they consider as un-Hindu — their blueprint for the future of India.

Sitaram Yechury is CPI(M) Politburo member and Rajya Sabha MP

 

Author’s note: The Hinduism/Brahmanism of India was imported and imposed onto India’s earlier population from outside invaders who happened to have lighter skin tones on average. It’s probably no coincidence that the upper caste of Hindu society, the Brahmins, are mostly lighter-skinned. The lowest caste, the so-called ‘untouchables’, who can still occasionally be killed for daring to touch a Brahmin, are predominantly the darker-skinned descendants of the vanquished people group. The whole horrible caste system seems designed to keep an entire group of people in a permanently servile state. Did I say ‘horrible system’? Indeed so. ‘Political correctness’ should not deter us from ‘speaking the truth in love’ (Ephesians 4:15)

That’s why it’s important to repeatedly emphasize the truth of Genesis history and what it means for all such ideas—they are simply untenable. Our true history should remind Christians in particular of two great facts. One is our fallen nature, so prone to thinking and acting wrongly towards others. The other is the immensely close relatedness of all members of our one human family.