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Can healthcare be made affordable?

By Dr Arun Mitra & Dr G S Grewal

The shocking stories of infants dying in hospitals in our country even after 70 years of Independence should ideally have shaken the ‘collective conscience’ of the society. These deaths are reflective of the pathetic state of affairs of healthcare in the country. The tragedy is that we have been quite tolerant and have accepted it to be a fate accompli. Worse is that, instead of debating the ways to improve the state of affairs, those responsible for such state of affairs are busy in a blame game.

According to the National Health Policy 2017 of the government, as many as 6 crore people in India slip down ‘below the poverty line’ after spending and exhausting all their resources on treatment. Nearly 40 percent of hospitalised patients borrow money for treatment and get entangled in that for very long periods. About 25 percent of them have to sell their property to meet the expenses on treatment. It may not be an exaggeration to say that quality healthcare and treatment are a luxury in India today.

Barring a few reputed institutions, like the AIIMS or PGI Chandigarh, the healthcare system has virtually collapsed. Even primary healthcare has gone beyond the reach of the common man. Not that there are not any hospitals and primary health centres available at the accessible distances: this is only because these are not run and managed properly. Most of these health centres remain without doctors. The doctors are either not posted or they prefer private practice to their official duties.

With the emergence of the (in)famous corporate hospitals across the country, a wrong perception about the availability of better healthcare has been built up. It is anybody’s guess as to how many people can afford treatment in such hospitals. In fact, it is the crass commercialisation resorted to by such hospitals that have led to the decline in healthcare across the country. The culture of cuts and commissions has percolated right to the bottom that even the basic healthcare comes at an exorbitant price.

The problem lies at the decision-making level and policy level. It is basically the vested interests and the conflict of interest of those who matter that do not allow any reform in the healthcare system. Unfortunately those who are supposed to bring in reforms to make health care accessible to all do not feel the pinch of the problem that exists today. The polity and the bureaucracy get all the benefits from the government but in practice support private investment in health care instead.

It is a double whammy for the poor and the common man. While on the one hand the hospital charges are unaffordable, the expenses on drugs are equally cruel. In the absence of a proper drug pricing policy, the prices of drugs are inhumanely exorbitant. For example, a medicine that one should be able to get for Rs 10 is available in the market for not less than Rs 100; in certain cases many times more.

Disease is a compulsion. Nobody falls ill of one’s own volition. Even when the person knows that he is being cheated, he has no option to but to pay through the nose. But not everybody is lucky to be able to pay.

Good health is directly related to the right to life. When the state fails to provide good healthcare to its people, it indirectly violates their right to life. And it is not something very difficult to provide to the people. There is a huge physical infrastructure available across the country from the primary to tertiary level. Every year tens of thousands of crores are allocated and spent on healthcare by the government. But it does not reach the right people. If the money is properly and judiciously spent and if responsibility is fixed, it will not be difficult to provide affordable healthcare to people. How is it that a government-run civil hospital in a district headquarters with massive infrastructure and adequate funds stands no comparison to a privately-run hospital with far less infrastructure? We need to learn the lessons. (IPA Service)

• Dr Arun Mitra – 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)

• Dr G S Grewal – Former President of Punjab Medical Council & Member core committee ADEH(Alliance of Doctors on Ethical Healthcare)

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