By Dr Arun Mitra
There have been several incidents recently which have drawn media attention on the exorbitant charges demanded by the corporate hospitals. Not that people were not protesting earlier; but media has become concerned about these now. The poor were already marginalised and devoid of quality healthcare, but now even the vocal middle class is feeling the pinch. India is among the 15 lowest spenders on health by the state. Our public health spending hovers around 1 percent of the GDP. Other similarly placed countries spend double of this. The developed countries spend 10 times of this. As a result of falling government expenditure, the private sector has grown. The policies of the previous government gave opportunity to the corporate sector to enter the healthcare and education sector as a lucrative business. This trend has gained further momentum after the present government came in power because of their extreme neo liberal approach towards economic development. These sectors have erstwhile been considered as key to socioeconomic development and an asset for the society. But this concept has completely changed after the shift in economic policies.
The public healthcare system comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centers (PHCs) in rural areas. On the contrary, private corporate sector has little concern towards primary health care. Their focus is on making profit. The talk of corporate social responsibility has resulted in nothing in concrete for the welfare of the poor. Many of such institutions have been provided with land at highly subsidised rates and other benefits like waiving off customs duties on imported equipments from the government, electricity at reduced rates etc. In lieu of that they are obliged to provide free treatment to a proportion of the poor patients. But several state governments are unable to make private hospitals comply with this clause. Moreover these institutions are not covered under the RTI Act. Therefore, getting information on such contentious issues is not easy.
As per the Indian Brand Equity Foundation, the healthcare industry size during 2008-20, is expected to record a compound annual growth rate (CAGR) of 16.5 per cent and touch US$ 280 billion by 2020. Private sector’s stress is on investing in the non communicable diseases, which have increased as a result of changes in life style. Advanced technologies have helped longevity and improved quality of life in case of non communicable diseases. The government investment in advanced technology is limited and has failed to meet the growing demand. This large gap in demand and supply of quality health care services and a growing capital demand owing to operational costs and technology acquisitions has pushed health care service providers to expand inorganically by merging with competitors or by accepting large capital injections.
In the initial stages, these private hospitals came up in the big cities. But now they are opening units in smaller cities also. This clearly shows that they are getting clientage from the small towns. And they also get cheap land, labour and electricity, also lesser laws to open their units.
After the entry of corporates in the health sector, India is experiencing 22-25 per cent growth in medical tourism and the industry is expected to double its size from present (April 2017) US$ 3 billion to US$ 6 billion by 2018. Medical tourist arrivals in India increased more than 50 per cent to 200,000 in 2016 from 130,000 in 2015. Some of these hospitals have agencies in other countries, which take care of the patients from their arrival in India to transport to the hospital and departure from India after treatment.
Going by the Global Hunger Index, India ranks 100 out of 119 countries, which is worse than Iraq, Bangladesh and even North Korea on an index that weighs the abilities of countries to provide food security for their citizens.
It is a challenge before the nation to meet the healthcare needs of this section of the society, who are not getting even the basic food requirements fulfilled. It would be naïve to expect from the corporate sector to take care of their health needs. Advertisements by the corporate hospitals for reduced cost health checkup packages may please a small section of the society in the cities, but the vast majority has no access to this type of facilities. Ultimately they are left to the mercy of quacks or faith healers. Lot of studies have been done on the health status of the marginalised sections, but they do not fall in the priority list of the government. The middle classes, who are now feeling the pinch of exorbitant cost of healthcare, must also speak for this section of society as well because these poverty stricken people have neither resources nor information and are not vocal enough to raise their issues. (IPA Service)
The writer is senior vice President Indian Doctors for Peace and Development, Former Chairman Ethical Committee Punjab Medical Council & Member core committee ADEH (Alliance of Doctors on Ethical Healthcare).
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